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Pharmacy | NDC EA = 25 GR"}]},{"description":"SILVADENE 1 % EX CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"61570013150","type":"NDC"}],"standard_charges":[{"gross_charge":242.84,"discounted_cash":242.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 GR"}]},{"description":"SSD 1 % EX CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"43598021055","type":"NDC"}],"standard_charges":[{"gross_charge":187.95,"discounted_cash":187.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 GR"}]},{"description":"SILVADENE 1 % EX CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"61570013125","type":"NDC"}],"standard_charges":[{"gross_charge":129.23,"discounted_cash":129.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 GR"}]},{"description":"SILVADENE 1 % EX CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"61570013140","type":"NDC"}],"standard_charges":[{"gross_charge":325.2,"discounted_cash":325.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 GR"}]},{"description":"PREMARIN 0.625 MG/GM VA CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00046087221","type":"NDC"}],"standard_charges":[{"gross_charge":2854.79,"discounted_cash":2854.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross 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GEL","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"58602060407","type":"NDC"}],"standard_charges":[{"gross_charge":207.1,"discounted_cash":207.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 GR"}]},{"description":"ZINC OXIDE 20 % EX OINT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00536131628","type":"NDC"}],"standard_charges":[{"gross_charge":48.81,"discounted_cash":48.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 GR"}]},{"description":"DIPHENHYDRAMINE-ZINC ACETATE 2-0.1 % EX 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AEPB","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00173089314","type":"NDC"}],"standard_charges":[{"gross_charge":1244.02,"discounted_cash":1244.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 28 UN"}]},{"description":"ARNUITY ELLIPTA 100 MCG/ACT IN AEPB","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00173087414","type":"NDC"}],"standard_charges":[{"gross_charge":528.04,"discounted_cash":528.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 14 UN"}]},{"description":"INCRUSE ELLIPTA 62.5 MCG/ACT IN 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Type: Pharmacy | NDC EA = 30 GR"}]},{"description":"NYAMYC 100000 UNIT/GM EX POWD","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00832046515","type":"NDC"}],"standard_charges":[{"gross_charge":238.76,"discounted_cash":238.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 GR"}]},{"description":"HURRICAINE ONE 20 % MT SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00283061026","type":"NDC"}],"standard_charges":[{"gross_charge":241.11,"discounted_cash":241.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 UN"}]},{"description":"NYSTOP 100000 UNIT/GM EX POWD","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00574200830","type":"NDC"}],"standard_charges":[{"gross_charge":168.29,"discounted_cash":168.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 GR"}]},{"description":"TRELEGY ELLIPTA 100-62.5-25 MCG/ACT IN AEPB","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00173088714","type":"NDC"}],"standard_charges":[{"gross_charge":1264.4,"discounted_cash":1264.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 28 UN"}]},{"description":"ANORO ELLIPTA 62.5-25 MCG/ACT IN 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Charge Type: Pharmacy | NDC EA = 30 GR"}]},{"description":"CAPSAICIN 0.1 % EX CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00536126456","type":"NDC"}],"standard_charges":[{"gross_charge":217.69,"discounted_cash":217.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 42.5 GR"}]},{"description":"TRIAMCINOLONE ACETONIDE 0.1 % EX OINT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"45802005535","type":"NDC"}],"standard_charges":[{"gross_charge":58.77,"discounted_cash":58.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 GR"}]},{"description":"CLOBETASOL PROPIONATE 0.05 % EX 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CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"45802005935","type":"NDC"}],"standard_charges":[{"gross_charge":99.36,"discounted_cash":99.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 GR"}]},{"description":"CLINDAMYCIN PHOS (TWICE-DAILY) 1 % EX GEL","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"21922002705","type":"NDC"}],"standard_charges":[{"gross_charge":166.0,"discounted_cash":166.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 GR"}]},{"description":"SILVER SULFADIAZINE 1 % EX 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Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Chemotherapy Without Acute Leukemia As Secondary Diagnosis Without Cc/Mcc","code_information":[{"code":"848","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17351.54,"maximum":35143.08,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35143.08},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":18858.38},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":19436.82},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":17351.54},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":20615.79},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":23887.68},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21264.73},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19932.02}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Radiotherapy","code_information":[{"code":"849","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":55349.67,"maximum":112102.85,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":112102.85},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":60156.32},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":62001.49},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":55349.67},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":65762.27},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":76199.27},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":67832.33},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":63581.13}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute Leukemia With Other Procedures","code_information":[{"code":"850","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":176896.27,"maximum":358278.15,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":358278.15},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":192258.22},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":198155.34},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":176896.27},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":210174.72},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":243531.12},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":216790.58},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":203203.83}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Infectious And Parasitic Diseases With O.R. Procedures With Mcc","code_information":[{"code":"853","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":100885.72,"maximum":204329.64,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":204329.64},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":109646.8},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":113009.98},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":100885.72},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":119864.76},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":138888.25},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":123637.85},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":115889.19}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":105464.36,"10th_percentile":105464.36,"90th_percentile":105464.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":17441.99,"10th_percentile":17441.99,"90th_percentile":17441.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":11677.82,"10th_percentile":11677.82,"90th_percentile":11677.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Infectious And Parasitic Diseases With O.R. Procedures With Cc","code_information":[{"code":"854","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":40817.19,"maximum":82669.39,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":82669.39},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":44361.82},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":45722.52},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":40817.19},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":48495.89},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":56192.57},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":50022.43},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":46887.41}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"1 through 10","median_amount":38958.89,"10th_percentile":38958.89,"90th_percentile":38958.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":33761.89,"10th_percentile":33761.89,"90th_percentile":33761.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Infectious And Parasitic Diseases With O.R. Procedures Without Cc/Mcc","code_information":[{"code":"855","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":30584.8,"maximum":61945.15,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":61945.15},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":33240.83},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":34260.43},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":30584.8},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":36338.54},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":42105.76},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37482.4},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35133.3}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Postoperative Or Post-Traumatic Infections With O.R. Procedures With Mcc","code_information":[{"code":"856","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":92920.84,"maximum":188197.91,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":188197.91},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":100990.24},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":104087.9},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":92920.84},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":110401.5},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":127923.09},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":113876.7},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":106739.79}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":27581.0,"10th_percentile":27581.0,"90th_percentile":27581.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Postoperative Or Post-Traumatic Infections With O.R. Procedures With Cc","code_information":[{"code":"857","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":43746.56,"maximum":88602.42,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":88602.42},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":47545.58},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":49003.94},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":43746.56},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":51976.35},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":60225.4},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":53612.45},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":50252.44}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Postoperative Or Post-Traumatic Infections With O.R. Procedures Without Cc/Mcc","code_information":[{"code":"858","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":28454.16,"maximum":57629.84,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":57629.84},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":30925.17},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":31873.73},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":28454.16},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":33807.08},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":39172.53},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34871.25},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32685.79}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Postoperative And Post-Traumatic Infections With Mcc","code_information":[{"code":"862","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":37254.54,"maximum":75453.76,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":75453.76},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":40489.79},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":41731.73},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":37254.54},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":44263.02},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":51287.92},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":45656.33},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":42794.94}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Postoperative And Post-Traumatic Infections Without Mcc","code_information":[{"code":"863","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":20385.1,"maximum":41287.11,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":41287.11},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":22155.38},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":22834.95},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":20385.1},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":24220.03},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":28063.94},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24982.43},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23416.72}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Fever And Inflammatory Conditions","code_information":[{"code":"864","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":18133.94,"maximum":36727.7,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":36727.7},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":19708.72},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":20313.24},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":18133.94},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":21545.37},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":24964.79},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22223.57},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20830.77}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Viral Illness With Mcc","code_information":[{"code":"865","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":30607.27,"maximum":61990.66,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":61990.66},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":33265.26},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":34285.6},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":30607.27},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":36365.24},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":42136.69},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37509.94},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35159.11}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Viral Illness Without Mcc","code_information":[{"code":"866","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17764.19,"maximum":35978.83,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35978.83},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":19306.86},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":19899.06},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":17764.19},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":21106.06},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":24455.76},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21770.44},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20406.03}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Infectious And Parasitic Diseases Diagnoses With Mcc","code_information":[{"code":"867","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":42759.89,"maximum":86604.06,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":86604.06},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":46473.23},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":47898.7},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":42759.89},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":50804.06},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":58867.06},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":52403.26},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":49119.03}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Infectious And Parasitic Diseases Diagnoses With Cc","code_information":[{"code":"868","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":21063.31,"maximum":42660.73,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":42660.73},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":22892.48},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":23594.66},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":21063.31},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":25025.83},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":28997.63},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25813.59},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24195.79}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Infectious And Parasitic Diseases Diagnoses Without Cc/Mcc","code_information":[{"code":"869","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14906.31,"maximum":30190.61,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30190.61},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":16200.8},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":16697.73},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":14906.31},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":17710.55},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":20521.35},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18268.04},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17123.14}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Septicemia Or Severe Sepsis With Mv >96 Hours","code_information":[{"code":"870","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":141194.25,"maximum":285968.81,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":285968.81},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":153455.78},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":158162.72},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":141194.25},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":167756.3},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":194380.55},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":173036.91},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":162192.3}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Septicemia Or Severe Sepsis Without Mv >96 Hours With Mcc","code_information":[{"code":"871","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":39681.39,"maximum":80369.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":80369.0},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":43127.39},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":44450.23},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":39681.39},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":47146.42},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":54628.93},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":48630.49},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":45582.71}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"1 through 10","median_amount":67843.21,"10th_percentile":67843.21,"90th_percentile":67843.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":4673.79,"10th_percentile":4673.79,"90th_percentile":4673.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"1 through 10","median_amount":47146.42,"10th_percentile":47146.42,"90th_percentile":47146.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14168.33,"10th_percentile":14168.33,"90th_percentile":14168.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13302.03,"10th_percentile":13302.03,"90th_percentile":13304.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13870.46,"10th_percentile":8682.91,"90th_percentile":14340.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":28361.6,"10th_percentile":28361.6,"90th_percentile":28361.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"1 through 10","median_amount":45582.71,"10th_percentile":45582.71,"90th_percentile":45582.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Septicemia Or Severe Sepsis Without Mv >96 Hours Without Mcc","code_information":[{"code":"872","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":20903.97,"maximum":42338.01,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":42338.01},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":22719.31},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":23416.17},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":20903.97},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":24836.51},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":28778.27},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25618.32},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24012.76}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"1 through 10","median_amount":28864.35,"10th_percentile":28864.35,"90th_percentile":28864.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":20412.01,"10th_percentile":20412.01,"90th_percentile":20412.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"1 through 10","median_amount":28623.24,"10th_percentile":28623.24,"90th_percentile":28623.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":3645.77,"10th_percentile":3645.77,"90th_percentile":3645.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6725.65,"10th_percentile":6725.65,"90th_percentile":6725.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":17253.33,"10th_percentile":17253.33,"90th_percentile":17253.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"1 through 10","median_amount":2595.98,"10th_percentile":2595.98,"90th_percentile":2595.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"1 through 10","median_amount":24012.76,"10th_percentile":24012.76,"90th_percentile":24012.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"O.R. Procedures With Principal Diagnosis Of Mental Illness","code_information":[{"code":"876","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":78952.18,"maximum":159906.37,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":159906.37},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":85808.51},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":88440.51},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":78952.18},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":93804.99},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":108692.58},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":96757.77},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":90693.74}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute Adjustment Reaction And Psychosocial Dysfunction","code_information":[{"code":"880","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":19614.97,"maximum":39727.31,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":39727.31},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":21318.36},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":21972.26},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":19614.97},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":23305.01},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":27003.7},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24038.61},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22532.05}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Depressive Neuroses","code_information":[{"code":"881","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":19220.71,"maximum":38928.8,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":38928.8},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":20889.86},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":21530.61},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":19220.71},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":22836.58},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":26460.93},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23555.43},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22079.16}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Neuroses Except Depressive","code_information":[{"code":"882","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":21935.59,"maximum":44427.4,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":44427.4},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":23840.51},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":24571.77},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":21935.59},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":26062.2},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":30198.48},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26882.58},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25197.79}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Disorders Of Personality And Impulse Control","code_information":[{"code":"883","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":40167.58,"maximum":81353.7,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":81353.7},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":43655.79},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":44994.84},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":40167.58},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":47724.07},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":55298.25},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":49226.32},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":46141.2}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Organic Disturbances And Intellectual Disability","code_information":[{"code":"884","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":32866.61,"maximum":66566.63,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":66566.63},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":35720.8},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":36816.46},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":32866.61},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":39049.61},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":45247.09},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":40278.81},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37754.45}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Psychoses","code_information":[{"code":"885","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":28533.83,"maximum":57791.2,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":57791.2},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":31011.75},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":31962.97},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":28533.83},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":33901.73},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":39282.21},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34968.89},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32777.31}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Behavioral And Developmental Disorders","code_information":[{"code":"886","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":42394.23,"maximum":85863.46,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":85863.46},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":46075.81},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":47489.09},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":42394.23},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":50369.61},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":58363.66},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":51955.14},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":48698.99}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Mental Disorder Diagnoses","code_information":[{"code":"887","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":21876.35,"maximum":44307.42,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":44307.42},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":23776.12},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":24505.4},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":21876.35},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":25991.81},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":30116.92},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26809.98},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25129.74}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Alcohol, Drug Abuse Or Dependence, Left Ama","code_information":[{"code":"894","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12602.03,"maximum":25523.62,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25523.62},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":13696.41},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":14116.52},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":12602.03},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":14972.78},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":17349.08},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15444.09},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14476.18}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"1 through 10","median_amount":17349.08,"10th_percentile":17349.08,"90th_percentile":17349.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9986.27,"10th_percentile":9986.27,"90th_percentile":9986.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Alcohol, Drug Abuse Or Dependence With Rehabilitation Therapy","code_information":[{"code":"895","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":28917.88,"maximum":58569.03,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":58569.03},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":31429.15},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":32393.17},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":28917.88},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":34358.03},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":39810.92},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35439.55},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33218.47}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy With Mcc","code_information":[{"code":"896","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":35648.9,"maximum":72201.77,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":72201.77},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":38744.71},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":39933.12},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":35648.9},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":42355.32},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":49077.45},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":43688.58},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":40950.52}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13464.45,"10th_percentile":13464.45,"90th_percentile":13464.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":31416.53,"10th_percentile":31416.53,"90th_percentile":31416.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy Without Mcc","code_information":[{"code":"897","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":18033.84,"maximum":36524.97,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":36524.97},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":19599.93},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":20201.11},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":18033.84},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":21426.44},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":24826.98},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22100.9},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20715.78}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"1 through 10","median_amount":34785.85,"10th_percentile":34785.85,"90th_percentile":34785.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"1 through 10","median_amount":18033.84,"10th_percentile":18033.84,"90th_percentile":18033.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"1 through 10","median_amount":20715.78,"10th_percentile":20715.78,"90th_percentile":20715.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Wound Debridements For Injuries With Mcc","code_information":[{"code":"901","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":85728.14,"maximum":173630.13,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":173630.13},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":93172.91},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":96030.8},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":85728.14},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":101855.68},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":118020.98},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":105061.88},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":98477.42}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Wound Debridements For Injuries With Cc","code_information":[{"code":"902","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":39109.41,"maximum":79210.52,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":79210.52},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":42505.73},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":43809.5},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":39109.41},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":46466.83},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":53841.48},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":47929.51},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":44925.66}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Wound Debridements For Injuries Without Cc/Mcc","code_information":[{"code":"903","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":23892.59,"maximum":48391.03,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":48391.03},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":25967.46},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":26763.96},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":23892.59},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":28387.36},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":32892.66},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29280.94},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27445.83}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Grafts For Injuries With Cc/Mcc","code_information":[{"code":"904","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":75034.09,"maximum":151970.84,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":151970.84},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":81550.17},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":84051.55},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":75034.09},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":89149.81},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":103298.59},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":91956.06},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":86192.96}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Grafts For Injuries Without Cc/Mcc","code_information":[{"code":"905","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":30302.9,"maximum":61374.19,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":61374.19},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":32934.45},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":33944.64},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":30302.9},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":36003.6},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":41717.66},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37136.92},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34809.46}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hand Procedures For Injuries","code_information":[{"code":"906","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":40126.72,"maximum":81270.95,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":81270.95},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":43611.39},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":44949.08},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":40126.72},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":47675.53},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":55242.01},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":49176.25},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":46094.26}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other O.R. Procedures For Injuries With Mcc","code_information":[{"code":"907","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":78429.22,"maximum":158847.2,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":158847.2},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":85240.14},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":87854.7},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":78429.22},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":93183.65},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":107972.63},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":96116.88},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":90093.01}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":58940.95,"10th_percentile":58940.95,"90th_percentile":58940.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other O.R. Procedures For Injuries With Cc","code_information":[{"code":"908","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":40757.95,"maximum":82549.4,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":82549.4},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":44297.43},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":45656.16},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":40757.95},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":48425.5},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":56111.01},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":49949.83},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":46819.36}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"1 through 10","median_amount":29790.28,"10th_percentile":29790.28,"90th_percentile":29790.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other O.R. Procedures For Injuries Without Cc/Mcc","code_information":[{"code":"909","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":26815.84,"maximum":54311.65,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":54311.65},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":29144.57},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":30038.51},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":26815.84},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":31860.54},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":36917.06},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32863.44},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30803.82}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Traumatic Injury With Mcc","code_information":[{"code":"913","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":33391.61,"maximum":67629.94,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":67629.94},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":36291.39},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":37404.55},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":33391.61},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":39673.38},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":45969.86},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":40922.21},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":38357.52}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Traumatic Injury Without Mcc","code_information":[{"code":"914","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":18088.99,"maximum":36636.68,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":36636.68},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":19659.87},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":20262.9},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":18088.99},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":21491.97},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":24902.92},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22168.49},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20779.14}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Allergic Reactions With Mcc","code_information":[{"code":"915","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":34351.72,"maximum":69574.52,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":69574.52},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":37334.88},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":38480.05},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":34351.72},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":40814.11},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":47291.64},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":42098.86},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":39460.43}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Allergic Reactions Without Mcc","code_information":[{"code":"916","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13611.18,"maximum":27567.5,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27567.5},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":14793.19},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":15246.94},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":13611.18},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":16171.77},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":18738.35},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16680.82},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15635.4}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":4745.72,"10th_percentile":4745.72,"90th_percentile":4745.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Poisoning And Toxic Effects Of Drugs With Mcc","code_information":[{"code":"917","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":32039.28,"maximum":64890.98,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":64890.98},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":34821.62},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":35889.7},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":32039.28},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":38066.64},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":44108.11},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":39264.89},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":36804.07}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":25110.6,"10th_percentile":25110.6,"90th_percentile":25110.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Poisoning And Toxic Effects Of Drugs Without Mcc","code_information":[{"code":"918","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17508.84,"maximum":35461.66,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35461.66},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":19029.33},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":19613.02},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":17508.84},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":20802.67},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":24104.22},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21457.5},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20112.71}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6278.77,"10th_percentile":6278.77,"90th_percentile":6278.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Complications Of Treatment With Mcc","code_information":[{"code":"919","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":37399.58,"maximum":75747.52,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":75747.52},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":40647.42},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":41894.2},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":37399.58},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":44435.35},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":51487.59},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":45834.08},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":42961.55}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Complications Of Treatment With Cc","code_information":[{"code":"920","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":20474.98,"maximum":41469.16,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":41469.16},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":22253.06},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":22935.63},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":20474.98},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":24326.82},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":28187.68},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25092.58},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23519.97}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Complications Of Treatment Without Cc/Mcc","code_information":[{"code":"921","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14062.64,"maximum":28481.86,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28481.86},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":15283.86},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":15752.66},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":14062.64},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":16708.16},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":19359.87},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17234.09},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16153.99}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5119.59,"10th_percentile":5119.59,"90th_percentile":5119.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Injury, Poisoning And Toxic Effect Diagnoses With Mcc","code_information":[{"code":"922","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":35736.74,"maximum":72379.68,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":72379.68},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":38840.18},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":40031.52},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":35736.74},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":42459.69},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":49198.38},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":43796.23},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":41051.42}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Injury, Poisoning And Toxic Effect Diagnoses Without Mcc","code_information":[{"code":"923","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":20789.58,"maximum":42106.32,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":42106.32},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":22594.98},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":23288.03},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":20789.58},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":24700.6},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":28620.78},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25478.12},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23881.35}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Extensive Burns Or Full Thickness Burns With Mv >96 Hours With Skin Graft","code_information":[{"code":"927","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":436148.01,"maximum":883355.59,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":883355.59},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":474023.8},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":488563.49},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":436148.01},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":518197.99},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":600440.11},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":534509.77},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":501010.83}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Full Thickness Burn With Skin Graft Or Inhalation Injury With Cc/Mcc","code_information":[{"code":"928","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":146523.92,"maximum":296763.29,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":296763.29},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":159248.29},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":164132.89},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":146523.92},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":174088.6},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":201717.84},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":179568.54},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":168314.58}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Full Thickness Burn With Skin Graft Or Inhalation Injury Without Cc/Mcc","code_information":[{"code":"929","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":65794.5,"maximum":133257.38,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":133257.38},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":71508.2},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":73701.57},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":65794.5},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":78172.04},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":90578.56},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":80632.73},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":75579.29}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Extensive Burns Or Full Thickness Burns With Mv >96 Hours Without Skin Graft","code_information":[{"code":"933","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":79550.72,"maximum":161118.63,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":161118.63},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":86459.03},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":89110.98},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":79550.72},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":94516.13},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":109516.59},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":97491.3},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":91381.3}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Full Thickness Burn Without Skin Graft Or Inhalation Injury","code_information":[{"code":"934","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":45158.14,"maximum":91461.36,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":91461.36},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":49079.74},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":50585.16},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":45158.14},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":53653.47},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":62168.7},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":55342.37},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":51873.94}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Non-Extensive Burns","code_information":[{"code":"935","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":42081.68,"maximum":85230.44,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":85230.44},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":45736.12},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":47138.98},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":42081.68},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":49998.26},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":57933.38},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":51572.1},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":48339.96}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"O.R. Procedures With Diagnoses Of Other Contact With Health Services With Mcc","code_information":[{"code":"939","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":74123.0,"maximum":150125.56,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":150125.56},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":80559.96},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":83030.97},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":74123.0},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":88067.32},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":102044.31},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":90839.5},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":85146.38}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"O.R. Procedures With Diagnoses Of Other Contact With Health Services With Cc","code_information":[{"code":"940","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":47738.19,"maximum":96686.9,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":96686.9},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":51883.85},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":53475.28},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":47738.19},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":56718.9},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":65720.64},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":58504.29},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":54837.7}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"O.R. Procedures With Diagnoses Of Other Contact With Health Services Without Cc/Mcc","code_information":[{"code":"941","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":41421.86,"maximum":83894.06,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":83894.06},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":45019.0},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":46399.86},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":41421.86},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":49214.31},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":57025.01},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":50763.47},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":47582.01}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Rehabilitation With Cc/Mcc","code_information":[{"code":"945","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":31634.8,"maximum":64071.78,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":64071.78},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":34382.02},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":35436.61},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":31634.8},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":37586.07},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":43551.28},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":38769.2},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":36339.45}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Rehabilitation Without Cc/Mcc","code_information":[{"code":"946","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":23426.83,"maximum":47447.7,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":47447.7},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":25461.25},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":26242.22},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":23426.83},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":27833.98},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":32251.46},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28710.14},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26910.81}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Signs And Symptoms With Mcc","code_information":[{"code":"947","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":25931.3,"maximum":52520.16,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":52520.16},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":28183.22},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":29047.68},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":25931.3},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":30809.61},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":35699.34},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31779.43},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29787.74}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Signs And Symptoms Without Mcc","code_information":[{"code":"948","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16352.61,"maximum":33119.89,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33119.89},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":17772.7},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":18317.84},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":16352.61},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":19428.94},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":22512.46},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20040.52},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18784.53}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Aftercare With Cc/Mcc","code_information":[{"code":"949","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":24303.19,"maximum":49222.65,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":49222.65},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":26413.72},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":27223.91},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":24303.19},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":28875.21},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":33457.93},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29784.14},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27917.5}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Aftercare Without Cc/Mcc","code_information":[{"code":"950","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12822.66,"maximum":25970.46,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25970.46},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":13936.2},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":14363.66},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":12822.66},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":15234.91},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":17652.81},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15714.47},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14729.61}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Factors Influencing Health Status","code_information":[{"code":"951","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11357.97,"maximum":23003.94,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23003.94},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":12344.31},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":12722.95},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":11357.97},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":13494.68},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":15636.39},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13919.46},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13047.1}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Craniotomy For Multiple Significant Trauma","code_information":[{"code":"955","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":137502.91,"maximum":278492.53,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":278492.53},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":149443.88},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":154027.76},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":137502.91},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":163370.53},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":189298.73},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":168513.09},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":157951.99}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Limb Reattachment, Hip And Femur Procedures For Multiple Significant Trauma","code_information":[{"code":"956","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":76870.56,"maximum":155690.36,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":155690.36},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":83546.13},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":86108.73},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":76870.56},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":91331.77},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":105826.85},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":94206.71},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":88302.56}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other O.R. Procedures For Multiple Significant Trauma With Mcc","code_information":[{"code":"957","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":155659.32,"maximum":315265.74,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":315265.74},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":169177.02},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":174366.17},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":155659.32},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":184942.59},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":214294.45},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":190764.2},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":178808.57}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other O.R. Procedures For Multiple Significant Trauma With Cc","code_information":[{"code":"958","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":86081.55,"maximum":174345.9,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":174345.9},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":93557.01},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":96426.67},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":86081.55},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":102275.57},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":118507.51},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":105494.99},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":98883.38}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other O.R. Procedures For Multiple Significant Trauma Without Cc/Mcc","code_information":[{"code":"959","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":60142.07,"maximum":121809.19,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":121809.19},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":65364.91},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":67369.84},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":60142.07},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":71456.25},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":82796.92},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":73705.54},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":69086.25}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Multiple Significant Trauma With Mcc","code_information":[{"code":"963","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":55846.07,"maximum":113108.24,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":113108.24},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":60695.83},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":62557.55},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":55846.07},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":66352.06},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":76882.66},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":68440.68},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":64151.35}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Multiple Significant Trauma With Cc","code_information":[{"code":"964","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":31307.95,"maximum":63409.79,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":63409.79},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":34026.79},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":35070.49},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":31307.95},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":37197.73},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":43101.31},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":38368.64},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35963.99}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Multiple Significant Trauma Without Cc/Mcc","code_information":[{"code":"965","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":19212.53,"maximum":38912.25,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":38912.25},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":20880.98},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":21521.46},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":19212.53},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":22826.88},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":26449.68},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23545.42},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22069.77}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hiv With Extensive O.R. Procedures With Mcc","code_information":[{"code":"969","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":125045.92,"maximum":253262.67,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":253262.67},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":135905.1},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":140073.71},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":125045.92},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":148570.07},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":172149.32},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":153246.75},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":143642.43}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hiv With Extensive O.R. Procedures Without Mcc","code_information":[{"code":"970","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":53876.81,"maximum":109119.79,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":109119.79},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":58555.55},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":60351.62},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":53876.81},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":64012.34},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":74171.6},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":66027.31},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":61889.23}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hiv With Major Related Condition With Mcc","code_information":[{"code":"974","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":58955.21,"maximum":119405.36,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":119405.36},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":64074.97},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":66040.34},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":58955.21},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":70046.11},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":81162.98},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":72251.01},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":67722.88}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"1 through 10","median_amount":64074.97,"10th_percentile":64074.97,"90th_percentile":64074.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hiv With Major Related Condition With Cc","code_information":[{"code":"975","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":26454.26,"maximum":53579.33,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":53579.33},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":28751.59},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":29633.49},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":26454.26},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":31430.95},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":36419.29},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32420.33},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30388.47}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hiv With Major Related Condition Without Cc/Mcc","code_information":[{"code":"976","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":18440.36,"maximum":37348.31,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37348.31},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":20041.75},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":20656.48},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":18440.36},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":21909.43},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":25386.63},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22599.09},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21182.76}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hiv With Or Without Other Related Condition","code_information":[{"code":"977","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":26509.42,"maximum":53691.04,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":53691.04},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":28811.54},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":29695.27},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":26509.42},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":31496.48},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":36495.22},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32487.92},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30451.83}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Extensive O.R. Procedures Unrelated To Principal Diagnosis With Mcc","code_information":[{"code":"981","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":95844.09,"maximum":194118.53,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":194118.53},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":104167.34},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":107362.46},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":95844.09},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":113874.68},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":131947.49},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":117459.21},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":110097.78}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc","code_information":[{"code":"982","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":50222.24,"maximum":101717.98,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":101717.98},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":54583.62},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":56257.86},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":50222.24},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":59670.25},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":69140.4},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":61548.55},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":57691.16}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/Mcc","code_information":[{"code":"983","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":35013.59,"maximum":70915.04,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":70915.04},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":38054.23},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":39221.46},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":35013.59},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":41600.49},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":48202.82},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":42909.99},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":40220.72}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"1 through 10","median_amount":67538.46,"10th_percentile":67538.46,"90th_percentile":67538.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With Mcc","code_information":[{"code":"987","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":70035.36,"maximum":141846.62,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":141846.62},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":76117.34},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":78452.08},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":70035.36},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":83210.7},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":96416.89},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":85829.99},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":80450.83}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc","code_information":[{"code":"988","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":33575.46,"maximum":68002.31,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":68002.31},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":36491.21},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":37610.5},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":33575.46},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":39891.82},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":46222.96},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":41147.53},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":38568.72}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/Mcc","code_information":[{"code":"989","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":24497.26,"maximum":49615.7,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":49615.7},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":26624.64},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":27441.29},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":24497.26},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":29105.78},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":33725.1},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30021.97},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28140.43}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Heart Transplant Or Implant Of Heart Assist System With Mcc","code_information":[{"code":"001","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":572472.23,"maximum":1159460.84,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1159460.84},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":622186.63},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":641270.9},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":572472.23},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":680168.08},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":788116.14},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":701578.34},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":657608.84}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Heart Transplant Or Implant Of Heart Assist System Without Mcc","code_information":[{"code":"002","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":231486.01,"maximum":468841.89,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":468841.89},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":251588.62},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":259305.58},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":231486.01},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":275034.12},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":318684.21},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":283691.61},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":265912.02}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck With Major","code_information":[{"code":"003","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":433588.39,"maximum":878171.42,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":878171.42},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":471241.89},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":485696.25},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":433588.39},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":515156.83},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":596916.3},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":531372.88},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":498070.54}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck Without Major O.R.","code_information":[{"code":"004","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":282956.4,"maximum":573087.82,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":573087.82},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":307528.78},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":316961.59},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":282956.4},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":336187.33},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":389542.92},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":346769.8},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":325036.95}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Liver Transplant With Mcc Or Intestinal Transplant","code_information":[{"code":"005","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":210622.89,"maximum":426586.63,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":426586.63},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":228913.72},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":235935.17},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":210622.89},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":250246.15},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":289962.19},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":258123.37},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":241946.19}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Liver Transplant Without Mcc","code_information":[{"code":"006","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":94724.64,"maximum":191851.24,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":191851.24},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":102950.67},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":106108.47},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":94724.64},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":112544.63},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":130406.35},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":116087.3},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":108811.84}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lung Transplant","code_information":[{"code":"007","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":264546.69,"maximum":535801.57,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":535801.57},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":287520.34},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":296339.43},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":264546.69},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":314314.3},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":364198.47},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":324208.26},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":303889.39}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Simultaneous Pancreas And Kidney Transplant","code_information":[{"code":"008","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":114490.77,"maximum":231884.72,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":231884.72},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":124433.33},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":128250.06},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":114490.77},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":136029.25},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":157618.17},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":140311.16},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":131517.54}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pancreas Transplant","code_information":[{"code":"010","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":146585.2,"maximum":296887.41,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":296887.41},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":159314.89},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":164201.54},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":146585.2},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":174161.41},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":201802.21},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":179643.65},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":168384.98}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With Mcc","code_information":[{"code":"011","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":111416.35,"maximum":225657.93,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":225657.93},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":121091.93},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":124806.17},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":111416.35},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":132376.46},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":153385.65},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":136543.39},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":127985.91}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With Cc","code_information":[{"code":"012","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":86124.45,"maximum":174432.78,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":174432.78},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":93603.63},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":96474.73},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":86124.45},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":102326.54},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":118566.57},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":105547.56},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":98932.66}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy Without Cc/Mcc","code_information":[{"code":"013","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":58869.41,"maximum":119231.59,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":119231.59},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":63981.72},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":65944.23},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":58869.41},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":69944.17},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":81044.86},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":72145.86},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":67624.32}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Allogeneic Bone Marrow Transplant","code_information":[{"code":"014","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":245501.66,"maximum":497228.59,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":497228.59},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":266821.42},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":275005.61},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":245501.66},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":291686.45},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":337979.4},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":300868.13},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":282012.04}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Autologous Bone Marrow Transplant With Cc/Mcc","code_information":[{"code":"016","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":121131.91,"maximum":245335.41,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":245335.41},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":131651.2},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":135689.33},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":121131.91},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":143919.75},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":166760.95},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":148450.04},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":139146.34}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Autologous Bone Marrow Transplant Without Cc/Mcc","code_information":[{"code":"017","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":110971.02,"maximum":224755.98,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":224755.98},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":120607.92},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":124307.32},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":110971.02},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":131847.35},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":152772.57},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":135997.63},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":127474.35}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Chimeric Antigen Receptor (Car) T-Cell And Other Immunotherapies","code_information":[{"code":"018","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":882138.24,"maximum":1786645.17,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1786645.17},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":958744.53},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":988152.01},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":882138.24},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":1048089.74},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":1214429.88},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1081081.4},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1013327.58}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Simultaneous Pancreas And Kidney Transplant With Hemodialysis","code_information":[{"code":"019","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":145745.61,"maximum":295186.94,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":295186.94},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":158402.39},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":163261.05},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":145745.61},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":173163.88},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":200646.36},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":178614.71},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":167420.52}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Mcc","code_information":[{"code":"020","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":160743.85,"maximum":325563.73,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":325563.73},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":174703.1},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":180061.75},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":160743.85},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":190983.64},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":221294.26},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":196995.41},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":184649.26}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Cc","code_information":[{"code":"021","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":108141.75,"maximum":219025.68,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":219025.68},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":117532.95},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":121138.03},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":108141.75},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":128485.82},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":148877.54},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":132530.28},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":124224.31}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage Without Cc/Mcc","code_information":[{"code":"022","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":64907.93,"maximum":131461.75,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":131461.75},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":70544.63},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":72708.44},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":64907.93},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":77118.68},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":89358.02},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":79546.21},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":74560.87}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis With Mcc Or Antineopla","code_information":[{"code":"023","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":117058.57,"maximum":237085.43,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":237085.43},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":127224.12},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":131126.45},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":117058.57},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":139080.11},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":161153.23},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":143458.06},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":134467.22}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Without Mcc","code_information":[{"code":"024","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":79912.29,"maximum":161850.95,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":161850.95},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":86852.0},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":89516.01},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":79912.29},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":94945.72},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":110014.36},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":97934.42},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":91796.65}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Craniotomy And Endovascular Intracranial Procedures With Mcc","code_information":[{"code":"025","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":92879.99,"maximum":188115.17,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":188115.17},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":100945.83},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":104042.14},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":92879.99},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":110352.96},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":127866.84},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":113826.63},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":106692.86}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Craniotomy And Endovascular Intracranial Procedures With Cc","code_information":[{"code":"026","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":63514.74,"maximum":128640.04,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":128640.04},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":69030.46},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":71147.82},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":63514.74},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":75463.39},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":87440.03},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":77838.82},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":72960.49}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Craniotomy And Endovascular Intracranial Procedures Without Cc/Mcc","code_information":[{"code":"027","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":51537.8,"maximum":104382.46,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":104382.46},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":56013.43},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":57731.52},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":51537.8},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":61233.31},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":70951.52},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":63160.8},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":59202.37}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Spinal Procedures With Mcc","code_information":[{"code":"028","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":122737.55,"maximum":248587.4,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":248587.4},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":133396.28},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":137487.93},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":122737.55},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":145827.45},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":168971.42},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":150417.79},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":140990.77}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Spinal Procedures With Cc Or Spinal Neurostimulators","code_information":[{"code":"029","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":69692.16,"maximum":141151.54,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":141151.54},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":75744.34},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":78067.64},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":69692.16},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":82802.94},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":95944.43},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":85409.41},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":80056.61}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Spinal Procedures Without Cc/Mcc","code_information":[{"code":"030","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":44843.55,"maximum":90824.2,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":90824.2},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":48737.83},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":50232.76},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":44843.55},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":53279.7},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":61735.61},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":54956.83},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":51512.56}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ventricular Shunt Procedures With Mcc","code_information":[{"code":"031","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":91527.65,"maximum":185376.21,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":185376.21},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":99476.06},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":102527.28},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":91527.65},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":108746.22},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":126005.1},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":112169.32},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":105139.41}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ventricular Shunt Procedures With Cc","code_information":[{"code":"032","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":43532.07,"maximum":88167.99,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":88167.99},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":47312.46},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":48763.67},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":43532.07},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":51721.5},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":59930.11},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":53349.59},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":50006.05}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ventricular Shunt Procedures Without Cc/Mcc","code_information":[{"code":"033","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":33969.72,"maximum":68800.82,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":68800.82},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":36919.71},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":38052.14},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":33969.72},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":40360.25},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":46765.74},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":41630.7},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":39021.61}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Carotid Artery Stent Procedures With Mcc","code_information":[{"code":"034","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":79070.66,"maximum":160146.34,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":160146.34},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":85937.28},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":88573.23},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":79070.66},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":93945.76},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":108855.7},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":96902.97},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":90829.85}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":25907.37,"10th_percentile":25907.37,"90th_percentile":25907.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Carotid Artery Stent Procedures With Cc","code_information":[{"code":"035","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":48833.13,"maximum":98904.55,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":98904.55},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":53073.88},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":54701.81},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":48833.13},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":58019.83},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":67228.03},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":59846.17},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":56095.47}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"1 through 10","median_amount":63841.0,"10th_percentile":63841.0,"90th_percentile":63841.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Carotid Artery Stent Procedures Without Cc/Mcc","code_information":[{"code":"036","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":39687.52,"maximum":80381.41,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":80381.41},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":43134.05},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":44457.09},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":39687.52},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":47153.7},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":54637.36},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":48638.0},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":45589.74}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Extracranial Procedures With Mcc","code_information":[{"code":"037","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":67251.02,"maximum":136207.35,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":136207.35},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":73091.2},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":75333.12},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":67251.02},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":79902.56},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":92583.73},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":82417.72},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":77252.42}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Extracranial Procedures With Cc","code_information":[{"code":"038","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":33146.47,"maximum":67133.45,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":67133.45},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":36024.97},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":37129.96},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":33146.47},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":39382.12},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":45632.38},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":40621.79},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":38075.93}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"1 through 10","median_amount":1499.27,"10th_percentile":1499.27,"90th_percentile":1499.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Extracranial Procedures Without Cc/Mcc","code_information":[{"code":"039","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":24013.11,"maximum":48635.14,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":48635.14},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":26098.45},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":26898.97},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":24013.11},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":28530.56},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":33058.59},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29428.64},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27584.28}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Peripheral, Cranial Nerve And Other Nervous System Procedures With Mcc","code_information":[{"code":"040","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":78876.59,"maximum":159753.29,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":159753.29},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":85726.36},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":88355.84},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":78876.59},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":93715.19},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":108588.53},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":96665.14},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":90606.92}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Peripheral, Cranial Nerve And Other Nervous System Procedures With Cc Or Peripheral Neurostimulator","code_information":[{"code":"041","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":44915.04,"maximum":90969.01,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":90969.01},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":48815.54},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":50312.85},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":44915.04},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":53364.65},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":61834.04},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":55044.45},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":51594.69}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Peripheral, Cranial Nerve And Other Nervous System Procedures Without Cc/Mcc","code_information":[{"code":"042","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":35293.46,"maximum":71481.86,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":71481.86},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":38358.4},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":39534.96},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":35293.46},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":41933.01},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":48588.11},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":43252.97},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":40542.21}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Spinal Disorders And Injuries With Cc/Mcc","code_information":[{"code":"052","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":37001.24,"maximum":74940.73,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":74940.73},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":40214.48},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":41447.98},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":37001.24},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":43962.06},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":50939.19},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":45345.9},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":42503.97}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Spinal Disorders And Injuries Without Cc/Mcc","code_information":[{"code":"053","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":20003.1,"maximum":40513.42,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":40513.42},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":21740.2},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":22407.03},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":20003.1},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":23766.16},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":27538.04},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24514.27},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22977.91}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Nervous System Neoplasms With Mcc","code_information":[{"code":"054","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":31191.51,"maximum":63173.96,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":63173.96},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":33900.23},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":34940.05},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":31191.51},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":37059.39},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":42941.01},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":38225.94},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35830.24}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Nervous System Neoplasms Without Mcc","code_information":[{"code":"055","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":20828.39,"maximum":42184.93,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":42184.93},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":22637.16},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":23331.51},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":20828.39},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":24746.71},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":28674.21},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25525.69},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23925.93}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Degenerative Nervous System Disorders With Mcc","code_information":[{"code":"056","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":47456.29,"maximum":96115.94,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":96115.94},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":51577.47},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":53159.5},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":47456.29},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":56383.96},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":65332.54},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":58158.81},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":54513.86}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Degenerative Nervous System Disorders Without Mcc","code_information":[{"code":"057","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":26466.52,"maximum":53604.15,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":53604.15},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":28764.91},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":29647.21},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":26466.52},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":31445.51},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":36436.16},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32435.35},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30402.55}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":1535.9,"10th_percentile":1535.9,"90th_percentile":1535.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7911.13,"10th_percentile":7911.13,"90th_percentile":7911.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Multiple Sclerosis And Cerebellar Ataxia With Mcc","code_information":[{"code":"058","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":34921.67,"maximum":70728.85,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":70728.85},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":37954.32},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":39118.49},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":34921.67},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":41491.27},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":48076.27},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":42797.33},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":40115.13}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Multiple Sclerosis And Cerebellar Ataxia With Cc","code_information":[{"code":"059","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":25349.11,"maximum":51341.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":51341.0},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":27550.46},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":28395.51},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":25349.11},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":30117.88},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":34897.83},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31065.93},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29118.96}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Multiple Sclerosis And Cerebellar Ataxia Without Cc/Mcc","code_information":[{"code":"060","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":18789.67,"maximum":38055.81,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":38055.81},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":20421.4},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":21047.78},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":18789.67},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":22324.47},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":25867.54},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23027.19},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21584.03}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With Mcc","code_information":[{"code":"061","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":56322.04,"maximum":114072.26,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":114072.26},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":61213.13},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":63090.72},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":56322.04},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":66917.57},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":77537.92},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":69024.0},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":64698.11}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With Cc","code_information":[{"code":"062","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":35896.08,"maximum":72702.39,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":72702.39},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":39013.35},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":40210.01},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":35896.08},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":42649.0},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":49417.74},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":43991.5},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":41234.46}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent Without Cc/Mcc","code_information":[{"code":"063","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":28676.83,"maximum":58080.82,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":58080.82},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":31167.17},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":32123.16},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":28676.83},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":34071.63},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":39479.07},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35144.13},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32941.57}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Intracranial Hemorrhage Or Cerebral Infarction With Mcc","code_information":[{"code":"064","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":41080.71,"maximum":83203.11,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":83203.11},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":44648.22},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":46017.71},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":41080.71},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":48808.98},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":56555.35},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":50345.39},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":47190.13}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Intracranial Hemorrhage Or Cerebral Infarction With Cc Or Tpa In 24 Hours","code_information":[{"code":"065","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":20638.41,"maximum":41800.15,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":41800.15},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":22430.68},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":23118.69},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":20638.41},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":24520.99},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":28412.67},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25292.86},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23707.7}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8224.05,"10th_percentile":8224.05,"90th_percentile":8224.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Intracranial Hemorrhage Or Cerebral Infarction Without Cc/Mcc","code_information":[{"code":"066","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13980.92,"maximum":28316.37,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28316.37},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":15195.05},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":15661.13},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":13980.92},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":16611.07},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":19247.38},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17133.95},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16060.13}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Precerebral Occlusion Without Infarction With Mcc","code_information":[{"code":"067","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":30002.6,"maximum":60765.99,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":60765.99},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":32608.08},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":33608.26},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":30002.6},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":35646.82},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":41304.25},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":36768.9},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34464.51}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Precerebral Occlusion Without Infarction Without Mcc","code_information":[{"code":"068","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17657.96,"maximum":35763.69,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35763.69},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":19191.41},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":19780.07},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":17657.96},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":20979.85},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":24309.52},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21640.25},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20284.01}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Transient Ischemia Without Thrombolytic","code_information":[{"code":"069","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16317.89,"maximum":33049.55,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33049.55},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":17734.96},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":18278.94},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":16317.89},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":19387.67},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":22464.65},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19997.96},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18744.64}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"1 through 10","median_amount":15064.85,"10th_percentile":15064.85,"90th_percentile":15064.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Cerebrovascular Disorders With Mcc","code_information":[{"code":"070","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":34008.53,"maximum":68879.44,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":68879.44},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":36961.89},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":38095.62},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":34008.53},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":40406.36},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":46819.17},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":41678.27},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":39066.2}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Cerebrovascular Disorders With Cc","code_information":[{"code":"071","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":20959.13,"maximum":42449.72,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":42449.72},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":22779.25},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":23477.96},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":20959.13},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":24902.05},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":28854.2},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25685.91},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24076.12}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Cerebrovascular Disorders Without Cc/Mcc","code_information":[{"code":"072","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15447.65,"maximum":31287.02,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31287.02},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":16789.15},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":17304.12},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":15447.65},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":18353.73},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":21266.61},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18931.47},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17744.99}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cranial And Peripheral Nerve Disorders With Mcc","code_information":[{"code":"073","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":32772.64,"maximum":66376.31,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":66376.31},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":35618.67},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":36711.2},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":32772.64},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":38937.97},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":45117.73},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":40163.65},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37646.5}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cranial And Peripheral Nerve Disorders Without Mcc","code_information":[{"code":"074","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":21057.18,"maximum":42648.32,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":42648.32},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":22885.82},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":23587.8},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":21057.18},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":25018.55},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":28989.19},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25806.08},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24188.75}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16686.32,"10th_percentile":16686.32,"90th_percentile":16686.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5923.46,"10th_percentile":5923.46,"90th_percentile":5923.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Viral Meningitis With Cc/Mcc","code_information":[{"code":"075","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":39170.69,"maximum":79334.65,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":79334.65},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":42572.34},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":43878.15},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":39170.69},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":46539.64},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":53925.85},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":48004.61},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":44996.06}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Viral Meningitis Without Cc/Mcc","code_information":[{"code":"076","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16857.19,"maximum":34141.82,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34141.82},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":18321.09},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":18883.05},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":16857.19},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":20028.43},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":23207.1},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20658.88},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19364.14}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Nontraumatic Stupor And Coma With Mcc","code_information":[{"code":"080","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":36974.68,"maximum":74886.94,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":74886.94},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":40185.62},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":41418.23},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":36974.68},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":43930.51},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":50902.63},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":45313.35},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":42473.46}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Nontraumatic Stupor And Coma Without Mcc","code_information":[{"code":"081","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":18295.32,"maximum":37054.55,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37054.55},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":19884.11},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":20494.01},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":18295.32},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":21737.11},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":25186.96},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22421.35},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21016.15}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Traumatic Stupor And Coma >1 Hour With Mcc","code_information":[{"code":"082","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":46690.24,"maximum":94564.41,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":94564.41},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":50744.89},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":52301.38},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":46690.24},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":55473.8},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":64277.93},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":57220.0},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":53633.89}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Traumatic Stupor And Coma >1 Hour With Cc","code_information":[{"code":"083","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":28513.4,"maximum":57749.83,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":57749.83},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":30989.55},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":31940.09},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":28513.4},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":33877.46},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":39254.08},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34943.85},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32753.84}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Traumatic Stupor And Coma >1 Hour Without Cc/Mcc","code_information":[{"code":"084","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":19525.08,"maximum":39545.27,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":39545.27},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":21220.67},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":21871.57},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":19525.08},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":23198.22},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":26879.96},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23928.45},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22428.8}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Traumatic Stupor And Coma <1 Hour With Mcc","code_information":[{"code":"085","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":46410.37,"maximum":93997.59,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":93997.59},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":50440.72},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":51987.89},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":46410.37},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":55141.28},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":63892.64},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":56877.02},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":53312.41}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Traumatic Stupor And Coma <1 Hour With Cc","code_information":[{"code":"086","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":26611.56,"maximum":53897.91,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":53897.91},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":28922.55},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":29809.68},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":26611.56},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":31617.83},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":36635.83},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32613.09},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30569.16}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"1 through 10","median_amount":23611.56,"10th_percentile":23611.56,"90th_percentile":23611.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Traumatic Stupor And Coma <1 Hour Without Cc/Mcc","code_information":[{"code":"087","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":18685.49,"maximum":37844.8,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37844.8},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":20308.17},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":20931.08},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":18685.49},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":22200.68},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":25724.11},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22899.51},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21464.35}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Concussion With Mcc","code_information":[{"code":"088","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":27614.57,"maximum":55929.37,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":55929.37},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":30012.66},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":30933.24},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":27614.57},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":32809.54},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":38016.67},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33842.31},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31721.34}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Concussion With Cc","code_information":[{"code":"089","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":22442.2,"maximum":45453.48,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":45453.48},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":24391.12},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":25139.26},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":22442.2},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":26664.12},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":30895.93},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27503.45},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25779.75}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Concussion Without Cc/Mcc","code_information":[{"code":"090","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16816.33,"maximum":34059.08,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34059.08},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":18276.69},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":18837.29},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":16816.33},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":19979.89},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":23150.85},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20608.81},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19317.21}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Disorders Of Nervous System With Mcc","code_information":[{"code":"091","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":35875.65,"maximum":72661.02,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":72661.02},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":38991.15},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":40187.12},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":35875.65},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":42624.73},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":49389.61},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":43966.47},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":41210.99}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Disorders Of Nervous System With Cc","code_information":[{"code":"092","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":20897.84,"maximum":42325.6,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":42325.6},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":22712.65},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":23409.31},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":20897.84},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":24829.23},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":28769.83},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25610.81},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24005.72}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Disorders Of Nervous System Without Cc/Mcc","code_information":[{"code":"093","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16266.82,"maximum":32946.12,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32946.12},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":17679.45},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":18221.73},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":16266.82},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":19327.0},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":22394.34},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19935.37},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18685.98}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Bacterial And Tuberculous Infections Of Nervous System With Mcc","code_information":[{"code":"094","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":71894.3,"maximum":145611.66,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":145611.66},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":78137.72},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":80534.43},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":71894.3},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":85419.36},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":98976.09},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":88108.18},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":82586.24}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Bacterial And Tuberculous Infections Of Nervous System With Cc","code_information":[{"code":"095","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":52687.9,"maximum":106711.82,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":106711.82},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":57263.4},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":59019.83},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":52687.9},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":62599.76},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":72534.84},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":64570.27},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":60523.51}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Bacterial And Tuberculous Infections Of Nervous System Without Cc/Mcc","code_information":[{"code":"096","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":52687.9,"maximum":106711.82,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":106711.82},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":57263.4},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":59019.83},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":52687.9},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":62599.76},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":72534.84},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":64570.27},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":60523.51}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Non-Bacterial Infection Of Nervous System Except Viral Meningitis With Mcc","code_information":[{"code":"097","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":73781.85,"maximum":149434.61,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":149434.61},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":80189.18},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":82648.82},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":73781.85},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":87662.0},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":101574.65},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":90421.41},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":84754.5}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Non-Bacterial Infection Of Nervous System Except Viral Meningitis With Cc","code_information":[{"code":"098","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":46880.22,"maximum":94949.19,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":94949.19},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":50951.37},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":52514.2},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":46880.22},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":55699.52},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":64539.47},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":57452.82},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":53852.12}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Non-Bacterial Infection Of Nervous System Except Viral Meningitis Without Cc/Mcc","code_information":[{"code":"099","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":27831.11,"maximum":56367.94,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":56367.94},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":30248.0},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":31175.8},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":27831.11},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":33066.81},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":38314.78},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34107.68},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31970.08}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Seizures With Mcc","code_information":[{"code":"100","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":39564.95,"maximum":80133.16,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":80133.16},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":43000.83},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":44319.79},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":39564.95},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":47008.07},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":54468.63},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":48487.79},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":45448.95}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":29992.41,"10th_percentile":29992.41,"90th_percentile":29992.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Seizures Without Mcc","code_information":[{"code":"101","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":18438.31,"maximum":37344.17,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37344.17},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":20039.53},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":20654.2},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":18438.31},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":21907.0},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":25383.82},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22596.59},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21180.41}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14373.43,"10th_percentile":14373.43,"90th_percentile":14373.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6665.28,"10th_percentile":6665.28,"90th_percentile":6665.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Headaches With Mcc","code_information":[{"code":"102","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":22897.75,"maximum":46376.12,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":46376.12},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":24886.22},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":25649.55},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":22897.75},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":27205.36},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":31523.07},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28061.73},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26303.04}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":17418.6,"10th_percentile":17418.6,"90th_percentile":17418.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Headaches Without Mcc","code_information":[{"code":"103","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17083.94,"maximum":34601.08,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34601.08},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":18567.53},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":19137.05},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":17083.94},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":20297.84},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":23519.26},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20936.77},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19624.62}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"1 through 10","median_amount":20297.84,"10th_percentile":20297.84,"90th_percentile":20297.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"1 through 10","median_amount":20936.77,"10th_percentile":20936.77,"90th_percentile":20936.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6136.16,"10th_percentile":6136.16,"90th_percentile":6136.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12539.18,"10th_percentile":12539.18,"90th_percentile":12539.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Orbital Procedures With Cc/Mcc","code_information":[{"code":"113","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":48028.27,"maximum":97274.41,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":97274.41},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":52199.12},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":53800.22},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":48028.27},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":57063.55},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":66119.99},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":58859.79},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":55170.91}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Orbital Procedures Without Cc/Mcc","code_information":[{"code":"114","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":27639.08,"maximum":55979.02,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":55979.02},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":30039.31},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":30960.7},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":27639.08},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":32838.66},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":38050.42},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33872.36},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31749.5}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Extraocular Procedures Except Orbit","code_information":[{"code":"115","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":31354.94,"maximum":63504.95,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":63504.95},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":34077.85},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":35123.12},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":31354.94},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":37253.56},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":43165.99},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":38426.22},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":36017.96}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Intraocular Procedures With Cc/Mcc","code_information":[{"code":"116","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":36935.87,"maximum":74808.33,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":74808.33},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":40143.44},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":41374.75},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":36935.87},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":43884.4},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":50849.2},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":45265.78},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":42428.87}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Intraocular Procedures Without Cc/Mcc","code_information":[{"code":"117","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":22162.34,"maximum":44886.65,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":44886.65},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":24086.95},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":24825.77},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":22162.34},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":26331.61},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":30510.64},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27160.47},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25458.26}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute Major Eye Infections With Cc/Mcc","code_information":[{"code":"121","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":23763.89,"maximum":48130.37,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":48130.37},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":25827.59},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":26619.79},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":23763.89},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":28234.45},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":32715.49},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29123.22},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27298.0}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute Major Eye Infections Without Cc/Mcc","code_information":[{"code":"122","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16052.32,"maximum":32511.69,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32511.69},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":17446.33},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":17981.46},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":16052.32},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":19072.15},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":22099.05},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19672.5},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18439.58}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Neurological Eye Disorders","code_information":[{"code":"123","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16313.8,"maximum":33041.28,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33041.28},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":17730.52},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":18274.36},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":16313.8},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":19382.82},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":22459.03},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19992.95},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18739.95}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Disorders Of The Eye With Mcc Or Thrombolytic Agent","code_information":[{"code":"124","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":27028.29,"maximum":54741.94,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":54741.94},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":29375.47},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":30276.5},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":27028.29},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":32112.96},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":37209.54},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33123.81},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31047.86}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Disorders Of The Eye Without Mcc","code_information":[{"code":"125","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15684.62,"maximum":31766.96,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31766.96},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":17046.7},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":17569.57},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":15684.62},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":18635.27},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":21592.84},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19221.87},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18017.19}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"1 through 10","median_amount":11411.04,"10th_percentile":11411.04,"90th_percentile":11411.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":700.0,"10th_percentile":700.0,"90th_percentile":700.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Sinus And Mastoid Procedures With Cc/Mcc","code_information":[{"code":"135","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":44328.76,"maximum":89781.58,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":89781.58},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":48178.34},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":49656.11},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":44328.76},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":52668.07},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":61026.91},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":54325.95},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":50921.22}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Sinus And Mastoid Procedures Without Cc/Mcc","code_information":[{"code":"136","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":20740.55,"maximum":42007.02,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":42007.02},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":22541.69},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":23233.11},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":20740.55},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":24642.35},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":28553.28},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25418.04},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23825.03}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Mouth Procedures With Cc/Mcc","code_information":[{"code":"137","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":30503.09,"maximum":61779.66,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":61779.66},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":33152.03},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":34168.9},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":30503.09},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":36241.46},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":41993.26},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37382.26},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35039.43}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Mouth Procedures Without Cc/Mcc","code_information":[{"code":"138","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":18103.29,"maximum":36665.64,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":36665.64},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":19675.41},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":20278.91},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":18103.29},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":21508.96},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":24922.6},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22186.02},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20795.57}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Salivary Gland Procedures","code_information":[{"code":"139","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":25242.88,"maximum":51125.85,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":51125.85},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":27435.01},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":28276.52},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":25242.88},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":29991.67},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":34751.59},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30935.75},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28996.94}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Head And Neck Procedures With Mcc","code_information":[{"code":"140","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":87131.55,"maximum":176472.52,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":176472.52},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":94698.19},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":97602.86},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":87131.55},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":103523.1},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":119953.03},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":106781.79},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":100089.53}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Head And Neck Procedures With Cc","code_information":[{"code":"141","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":44555.51,"maximum":90240.83,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":90240.83},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":48424.78},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":49910.11},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":44555.51},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":52937.48},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":61339.08},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":54603.84},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":51181.69}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Head And Neck Procedures Without Cc/Mcc","code_information":[{"code":"142","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":32611.26,"maximum":66049.45,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":66049.45},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":35443.27},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":36530.42},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":32611.26},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":38746.22},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":44895.56},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":39965.87},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37461.12}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Ear, Nose, Mouth And Throat O.R. Procedures With Mcc","code_information":[{"code":"143","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":76535.54,"maximum":155011.83,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":155011.83},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":83182.01},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":85733.45},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":76535.54},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":90933.73},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":105365.63},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":93796.13},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":87917.72}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Ear, Nose, Mouth And Throat O.R. Procedures With Cc","code_information":[{"code":"144","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":35399.68,"maximum":71697.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":71697.0},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":38473.85},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":39653.95},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":35399.68},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":42059.22},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":48734.35},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":43383.15},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":40664.23}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Ear, Nose, Mouth And Throat O.R. Procedures Without Cc/Mcc","code_information":[{"code":"145","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":24560.58,"maximum":49743.96,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":49743.96},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":26693.46},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":27512.23},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":24560.58},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":29181.02},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":33812.28},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30099.58},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28213.17}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ear, Nose, Mouth And Throat Malignancy With Mcc","code_information":[{"code":"146","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":43254.25,"maximum":87605.31,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":87605.31},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":47010.51},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":48452.46},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":43254.25},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":51391.42},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":59547.64},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":53009.11},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":49686.91}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ear, Nose, Mouth And Throat Malignancy With Cc","code_information":[{"code":"147","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":25974.2,"maximum":52607.04,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":52607.04},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":28229.84},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":29095.73},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":25974.2},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":30860.58},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":35758.39},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31832.0},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29837.02}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ear, Nose, Mouth And Throat Malignancy Without Cc/Mcc","code_information":[{"code":"148","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16283.16,"maximum":32979.22,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32979.22},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":17697.21},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":18240.04},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":16283.16},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":19346.41},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":22416.84},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19955.4},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18704.75}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Dysequilibrium","code_information":[{"code":"149","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15353.68,"maximum":31096.7,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31096.7},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":16687.02},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":17198.86},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":15353.68},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":18242.08},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":21137.25},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18816.31},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17637.05}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5551.0,"10th_percentile":5551.0,"90th_percentile":5551.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Epistaxis With Mcc","code_information":[{"code":"150","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":27199.88,"maximum":55089.48,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":55089.48},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":29561.96},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":30468.71},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":27199.88},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":32316.84},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":37445.77},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33334.1},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31244.98}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Epistaxis Without Mcc","code_information":[{"code":"151","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14994.15,"maximum":30368.52,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30368.52},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":16296.27},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":16796.12},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":14994.15},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":17814.91},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":20642.28},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18375.69},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17224.04}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"1 through 10","median_amount":18375.69,"10th_percentile":18375.69,"90th_percentile":18375.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Otitis Media And Uri With Mcc","code_information":[{"code":"152","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":24149.98,"maximum":48912.34,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":48912.34},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":26247.2},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":27052.28},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":24149.98},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":28693.18},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":33247.01},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29596.38},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27741.51}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Otitis Media And Uri Without Mcc","code_information":[{"code":"153","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15079.95,"maximum":30542.29,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30542.29},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":16389.52},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":16892.23},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":15079.95},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":17916.85},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":20760.4},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18480.84},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17322.6}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"1 through 10","median_amount":18480.84,"10th_percentile":18480.84,"90th_percentile":18480.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Ear, Nose, Mouth And Throat Diagnoses With Mcc","code_information":[{"code":"154","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":31939.18,"maximum":64688.25,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":64688.25},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":34712.83},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":35777.57},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":31939.18},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":37947.71},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":43970.31},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":39142.22},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":36689.09}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Ear, Nose, Mouth And Throat Diagnoses With Cc","code_information":[{"code":"155","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":18722.26,"maximum":37919.27,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37919.27},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":20348.13},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":20972.27},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":18722.26},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":22244.37},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":25774.73},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22944.58},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21506.59}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"1 through 10","median_amount":17837.44,"10th_percentile":17837.44,"90th_percentile":17837.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Ear, Nose, Mouth And Throat Diagnoses Without Cc/Mcc","code_information":[{"code":"156","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14117.79,"maximum":28593.57,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28593.57},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":15343.8},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":15814.44},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":14117.79},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":16773.69},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":19435.81},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17301.69},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16217.35}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Dental And Oral Diseases With Mcc","code_information":[{"code":"157","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":35070.79,"maximum":71030.88,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":71030.88},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":38116.39},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":39285.53},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":35070.79},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":41668.45},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":48281.57},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":42980.09},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":40286.43}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Dental And Oral Diseases With Cc","code_information":[{"code":"158","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":18585.39,"maximum":37642.07,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37642.07},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":20199.38},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":20818.95},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":18585.39},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":22081.76},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":25586.31},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22776.84},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21349.37}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"1 through 10","median_amount":11108.12,"10th_percentile":11108.12,"90th_percentile":11108.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"1 through 10","median_amount":21145.5,"10th_percentile":21145.5,"90th_percentile":21145.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Dental And Oral Diseases Without Cc/Mcc","code_information":[{"code":"159","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14473.24,"maximum":29313.48,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29313.48},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":15730.12},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":16212.61},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":14473.24},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":17196.0},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":19925.15},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17737.3},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16625.66}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Chest Procedures With Mcc","code_information":[{"code":"163","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":91554.21,"maximum":185429.99,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":185429.99},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":99504.92},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":102557.03},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":91554.21},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":108777.77},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":126041.66},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":112201.86},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":105169.92}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Chest Procedures With Cc","code_information":[{"code":"164","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":51560.27,"maximum":104427.98,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":104427.98},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":56037.85},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":57756.69},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":51560.27},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":61260.0},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":70982.45},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":63188.34},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":59228.18}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Chest Procedures Without Cc/Mcc","code_information":[{"code":"165","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":39103.28,"maximum":79198.11,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":79198.11},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":42499.07},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":43802.64},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":39103.28},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":46459.55},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":53833.05},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":47922.0},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":44918.62}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Respiratory System O.R. Procedures With Mcc","code_information":[{"code":"166","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":76353.74,"maximum":154643.6,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":154643.6},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":82984.42},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":85529.79},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":76353.74},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":90717.72},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":105115.34},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":93573.32},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":87708.87}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":25190.25,"10th_percentile":25190.25,"90th_percentile":25190.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Respiratory System O.R. Procedures With Cc","code_information":[{"code":"167","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":36839.86,"maximum":74613.87,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":74613.87},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":40039.09},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":41267.2},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":36839.86},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":43770.32},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":50717.02},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":45148.12},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":42318.58}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Respiratory System O.R. Procedures Without Cc/Mcc","code_information":[{"code":"168","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":27912.82,"maximum":56533.43,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":56533.43},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":30336.81},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":31267.33},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":27912.82},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":33163.89},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":38427.27},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34207.82},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32063.94}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ultrasound Accelerated And Other Thrombolysis With Principal Diagnosis Pulmonary Embolism","code_information":[{"code":"173","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":60801.9,"maximum":123145.57,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":123145.57},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":66082.03},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":68108.96},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":60801.9},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":72240.2},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":83705.3},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":74514.17},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":69844.2}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pulmonary Embolism With Mcc Or Acute Cor Pulmonale","code_information":[{"code":"175","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":28059.9,"maximum":56831.33,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":56831.33},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":30496.67},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":31432.09},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":28059.9},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":33338.65},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":38629.75},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34388.08},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32232.9}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pulmonary Embolism Without Mcc","code_information":[{"code":"176","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16444.54,"maximum":33306.07,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33306.07},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":17872.61},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":18420.82},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":16444.54},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":19538.16},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":22639.02},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20153.18},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18890.13}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"1 through 10","median_amount":3030.65,"10th_percentile":3030.65,"90th_percentile":3030.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Respiratory Infections And Inflammations With Mcc","code_information":[{"code":"177","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":31922.84,"maximum":64655.15,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":64655.15},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":34695.07},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":35759.26},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":31922.84},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":37928.29},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":43947.81},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":39122.19},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":36670.32}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12949.18,"10th_percentile":12949.18,"90th_percentile":12949.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6147.14,"10th_percentile":6147.14,"90th_percentile":6147.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Respiratory Infections And Inflammations With Cc","code_information":[{"code":"178","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":19937.73,"maximum":40381.02,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":40381.02},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":21669.15},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":22333.81},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":19937.73},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":23688.5},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":27448.05},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24434.16},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22902.82}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Respiratory Infections And Inflammations Without Cc/Mcc","code_information":[{"code":"179","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15423.14,"maximum":31237.37,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31237.37},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":16762.51},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":17276.67},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":15423.14},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":18324.61},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":21232.87},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18901.43},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17716.83}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Respiratory Neoplasms With Mcc","code_information":[{"code":"180","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":36075.85,"maximum":73066.48,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":73066.48},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":39208.73},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":40411.38},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":36075.85},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":42862.59},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":49665.22},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":44211.81},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":41440.96}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Respiratory Neoplasms With Cc","code_information":[{"code":"181","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":21878.39,"maximum":44311.55,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":44311.55},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":23778.34},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":24507.69},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":21878.39},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":25994.24},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":30119.73},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26812.49},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25132.09}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Respiratory Neoplasms Without Cc/Mcc","code_information":[{"code":"182","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15398.63,"maximum":31187.72,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31187.72},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":16735.87},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":17249.21},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":15398.63},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":18295.48},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":21199.12},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18871.38},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17688.67}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Chest Trauma With Mcc","code_information":[{"code":"183","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":31252.8,"maximum":63298.08,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":63298.08},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":33966.84},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":35008.7},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":31252.8},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":37132.2},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":43025.38},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":38301.05},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35900.63}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Chest Trauma With Cc","code_information":[{"code":"184","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":21737.43,"maximum":44026.07,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":44026.07},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":23625.15},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":24349.8},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":21737.43},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":25826.77},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":29925.68},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26639.74},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24970.17}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Chest Trauma Without Cc/Mcc","code_information":[{"code":"185","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16066.62,"maximum":32540.65,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32540.65},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":17461.87},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":17997.48},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":16066.62},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":19089.14},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":22118.74},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19690.03},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18456.01}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pleural Effusion With Mcc","code_information":[{"code":"186","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":31837.04,"maximum":64481.38,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":64481.38},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":34601.82},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":35663.16},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":31837.04},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":37826.35},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":43829.7},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":39017.05},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":36571.76}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7688.41,"10th_percentile":7688.41,"90th_percentile":7688.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pleural Effusion With Cc","code_information":[{"code":"187","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":20205.33,"maximum":40923.02,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":40923.02},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":21960.0},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":22633.58},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":20205.33},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":24006.45},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":27816.46},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24762.12},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23210.22}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pleural Effusion Without Cc/Mcc","code_information":[{"code":"188","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14650.96,"maximum":29673.43,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29673.43},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":15923.27},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":16411.69},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":14650.96},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":17407.16},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":20169.82},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17955.1},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16829.82}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pulmonary Edema And Respiratory Failure","code_information":[{"code":"189","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":25236.75,"maximum":51113.44,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":51113.44},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":27428.35},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":28269.66},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":25236.75},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":29984.39},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":34743.15},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30928.24},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28989.9}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":21023.53,"10th_percentile":21023.53,"90th_percentile":21023.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8779.02,"10th_percentile":8779.02,"90th_percentile":8779.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Chronic Obstructive Pulmonary Disease With Mcc","code_information":[{"code":"190","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":22628.1,"maximum":45829.98,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":45829.98},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":24593.16},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":25347.5},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":22628.1},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":26884.99},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":31151.85},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27731.27},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25993.29}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":3542.67,"10th_percentile":3542.67,"90th_percentile":3542.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8008.62,"10th_percentile":8008.62,"90th_percentile":8008.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":18549.37,"10th_percentile":18549.37,"90th_percentile":18549.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8835.77,"10th_percentile":8835.77,"90th_percentile":8835.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Chronic Obstructive Pulmonary Disease With Cc","code_information":[{"code":"191","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17220.8,"maximum":34878.28,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34878.28},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":18716.29},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":19290.37},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":17220.8},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":20460.45},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":23707.69},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21104.51},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19781.84}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":251.49,"10th_percentile":251.49,"90th_percentile":251.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Chronic Obstructive Pulmonary Disease Without Cc/Mcc","code_information":[{"code":"192","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13114.78,"maximum":26562.11,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26562.11},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":14253.68},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":14690.89},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":13114.78},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":15581.98},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":18054.97},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16072.47},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15065.17}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Simple Pneumonia And Pleurisy With Mcc","code_information":[{"code":"193","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":26850.56,"maximum":54381.99,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":54381.99},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":29182.31},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":30077.42},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":26850.56},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":31901.8},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":36964.87},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32906.0},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30843.71}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10052.74,"10th_percentile":10052.74,"90th_percentile":10052.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":22749.87,"10th_percentile":22749.87,"90th_percentile":22749.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Simple Pneumonia And Pleurisy With Cc","code_information":[{"code":"194","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16462.93,"maximum":33343.31,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33343.31},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":17892.59},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":18441.41},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":16462.93},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":19560.0},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":22664.33},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20175.71},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18911.25}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":1601.05,"10th_percentile":1601.05,"90th_percentile":1601.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5568.71,"10th_percentile":5568.71,"90th_percentile":5568.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Simple Pneumonia And Pleurisy Without Cc/Mcc","code_information":[{"code":"195","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12839.0,"maximum":26003.56,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26003.56},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":13953.96},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":14381.97},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":12839.0},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":15254.32},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":17675.31},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15734.5},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14748.38}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Interstitial Lung Disease With Mcc","code_information":[{"code":"196","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":38551.72,"maximum":78081.01,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":78081.01},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":41899.61},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":43184.8},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":38551.72},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":45804.23},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":53073.73},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":47246.05},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":44285.04}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Interstitial Lung Disease With Cc","code_information":[{"code":"197","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":19388.21,"maximum":39268.06,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":39268.06},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":21071.92},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":21718.26},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":19388.21},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":23035.61},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":26691.54},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23760.72},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22271.58}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Interstitial Lung Disease Without Cc/Mcc","code_information":[{"code":"198","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14630.53,"maximum":29632.06,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29632.06},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":15901.07},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":16388.8},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":14630.53},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":17382.89},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":20141.69},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17930.07},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16806.35}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pneumothorax With Mcc","code_information":[{"code":"199","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":36037.03,"maximum":72987.87,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":72987.87},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":39166.55},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":40367.9},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":36037.03},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":42816.47},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":49611.78},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":44164.24},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":41396.37}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pneumothorax With Cc","code_information":[{"code":"200","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":22456.5,"maximum":45482.44,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":45482.44},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":24406.66},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":25155.28},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":22456.5},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":26681.11},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":30915.61},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27520.98},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25796.17}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pneumothorax Without Cc/Mcc","code_information":[{"code":"201","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14608.06,"maximum":29586.55,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29586.55},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":15876.65},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":16363.63},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":14608.06},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":17356.19},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":20110.76},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17902.53},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16780.54}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Bronchitis And Asthma With Cc/Mcc","code_information":[{"code":"202","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":19839.67,"maximum":40182.43,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":40182.43},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":21562.58},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":22223.97},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":19839.67},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":23572.0},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":27313.06},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24313.99},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22790.18}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":4999.85,"10th_percentile":4999.85,"90th_percentile":4999.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15940.07,"10th_percentile":15940.07,"90th_percentile":15940.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Bronchitis And Asthma Without Cc/Mcc","code_information":[{"code":"203","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13686.76,"maximum":27720.58,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27720.58},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":14875.34},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":15331.61},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":13686.76},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":16261.57},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":18842.41},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16773.45},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15722.22}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5008.85,"10th_percentile":5008.85,"90th_percentile":5008.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Respiratory Signs And Symptoms","code_information":[{"code":"204","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16493.57,"maximum":33405.37,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33405.37},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":17925.89},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":18475.73},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":16493.57},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":19596.41},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":22706.51},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20213.26},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18946.45}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Respiratory System Diagnoses With Mcc","code_information":[{"code":"205","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":37403.67,"maximum":75755.79,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":75755.79},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":40651.86},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":41898.77},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":37403.67},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":44440.2},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":51493.21},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":45839.09},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":42966.25}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Respiratory System Diagnoses Without Mcc","code_information":[{"code":"206","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":19224.79,"maximum":38937.07,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":38937.07},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":20894.3},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":21535.19},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":19224.79},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":22841.44},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":26466.56},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23560.44},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22083.85}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7512.24,"10th_percentile":7512.24,"90th_percentile":7512.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Respiratory System Diagnosis With Ventilator Support >96 Hours","code_information":[{"code":"207","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":131448.05,"maximum":266229.28,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":266229.28},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":142863.21},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":147245.24},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":131448.05},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":156176.6},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":180963.07},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":161092.71},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":150996.67}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"1 through 10","median_amount":9053.59,"10th_percentile":9053.59,"90th_percentile":9053.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Respiratory System Diagnosis With Ventilator Support <=96 Hours","code_information":[{"code":"208","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":56150.44,"maximum":113724.71,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":113724.71},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":61026.64},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":62898.5},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":56150.44},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":66713.7},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":77301.69},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":68813.7},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":64500.99}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":7636.51,"10th_percentile":7636.51,"90th_percentile":7636.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Complex Aortic Arch Procedures","code_information":[{"code":"209","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":231220.45,"maximum":468304.03,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":468304.03},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":251300.0},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":259008.1},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":231220.45},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":274718.59},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":318318.61},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":283366.16},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":265606.96}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Concomitant Aortic And Mitral Valve Procedures","code_information":[{"code":"212","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":222136.11,"maximum":449905.01,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":449905.01},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":241426.77},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":248832.03},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":222136.11},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":263925.28},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":305812.31},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":272233.09},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":255171.63}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Endovascular Abdominal Aorta With Iliac Branch Procedures","code_information":[{"code":"213","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":116580.55,"maximum":236117.28,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":236117.28},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":126704.59},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":130590.99},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":116580.55},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":138512.17},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":160495.15},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":142872.24},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":133918.12}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Heart Assist System Implant","code_information":[{"code":"215","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":203401.6,"maximum":411960.92,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":411960.92},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":221065.31},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":227846.03},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":203401.6},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":241666.35},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":280020.71},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":249273.5},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":233650.96}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With Mcc","code_information":[{"code":"216","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":199843.04,"maximum":404753.57,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":404753.57},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":217197.73},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":223859.81},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":199843.04},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":237438.34},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":275121.68},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":244912.4},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":229563.18}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With Cc","code_information":[{"code":"217","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":134320.23,"maximum":272046.46,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":272046.46},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":145984.81},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":150462.59},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":134320.23},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":159589.11},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":184917.16},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":164612.64},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":154295.99}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization Without Cc/Mcc","code_information":[{"code":"218","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":134320.23,"maximum":272046.46,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":272046.46},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":145984.81},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":150462.59},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":134320.23},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":159589.11},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":184917.16},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":164612.64},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":154295.99}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Mcc","code_information":[{"code":"219","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":156852.31,"maximum":317681.98,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":317681.98},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":170473.62},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":175702.54},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":156852.31},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":186360.02},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":215936.83},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":192226.24},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":180178.99}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Cc","code_information":[{"code":"220","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":108938.44,"maximum":220639.27,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":220639.27},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":118398.83},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":122030.46},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":108938.44},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":129432.39},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":149974.33},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":133506.65},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":125139.48}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization Without Cc/M","code_information":[{"code":"221","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":102961.21,"maximum":208533.23,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":208533.23},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":111902.52},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":115334.9},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":102961.21},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":122330.69},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":141745.54},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":126181.41},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":118273.33}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Cardiothoracic Procedures With Mcc","code_information":[{"code":"228","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":101065.49,"maximum":204693.73,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":204693.73},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":109842.17},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":113211.35},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":101065.49},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":120078.35},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":139135.73},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":123858.16},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":116095.69}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Cardiothoracic Procedures Without Mcc","code_information":[{"code":"229","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":64337.99,"maximum":130307.41,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":130307.41},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":69925.2},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":72070.01},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":64337.99},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":76441.51},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":88573.39},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":78847.73},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":73906.17}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Coronary Bypass With Ptca With Mcc","code_information":[{"code":"231","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":172206.0,"maximum":348778.68,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":348778.68},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":187160.64},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":192901.4},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":172206.0},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":204602.1},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":237074.08},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":211042.55},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":197816.03}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Coronary Bypass With Ptca Without Mcc","code_information":[{"code":"232","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":123846.79,"maximum":250834.01,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":250834.01},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":134601.85},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":138730.48},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":123846.79},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":147145.36},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":170498.5},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":151777.19},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":142264.97}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Coronary Bypass With Cardiac Catheterization Or Open Ablation With Mcc","code_information":[{"code":"233","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":156176.15,"maximum":316312.5,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":316312.5},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":169738.73},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":174945.11},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":156176.15},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":185556.65},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":215005.96},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":191397.58},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":179402.26}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Coronary Bypass With Cardiac Catheterization Or Open Ablation Without Mcc","code_information":[{"code":"234","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":111592.04,"maximum":226013.75,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":226013.75},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":121282.87},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":125002.96},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":111592.04},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":132585.19},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":153627.51},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":136758.69},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":128187.72}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Coronary Bypass Without Cardiac Catheterization With Mcc","code_information":[{"code":"235","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":119883.76,"maximum":242807.46,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":242807.46},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":130294.66},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":134291.17},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":119883.76},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":142436.79},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":165042.64},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":146920.4},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":137712.57}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Coronary Bypass Without Cardiac Catheterization Without Mcc","code_information":[{"code":"236","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":85568.81,"maximum":173307.41,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":173307.41},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":92999.74},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":95852.31},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":85568.81},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":101666.36},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":117801.62},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":104866.61},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":98294.38}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Amputation For Circulatory System Disorders Except Upper Limb And Toe With Mcc","code_information":[{"code":"239","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":100540.49,"maximum":203630.42,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":203630.42},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":109271.58},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":112623.26},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":100540.49},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":119454.58},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":138412.97},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":123214.76},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":115492.61}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Amputation For Circulatory System Disorders Except Upper Limb And Toe With Cc","code_information":[{"code":"240","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":58230.01,"maximum":117936.59,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":117936.59},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":63286.8},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":65227.99},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":58230.01},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":69184.49},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":80164.61},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":71362.27},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":66889.83}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Amputation For Circulatory System Disorders Except Upper Limb And Toe Without Cc/Mcc","code_information":[{"code":"241","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":28280.52,"maximum":57278.17,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":57278.17},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":30736.45},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":31679.23},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":28280.52},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":33600.77},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":38933.48},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34658.45},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32486.33}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Permanent Cardiac Pacemaker Implant With Mcc","code_information":[{"code":"242","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":65222.52,"maximum":132098.91,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":132098.91},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":70886.55},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":73060.84},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":65222.52},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":77492.45},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":89791.11},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":79931.75},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":74922.24}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Permanent Cardiac Pacemaker Implant With Cc","code_information":[{"code":"243","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":43530.03,"maximum":88163.86,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":88163.86},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":47310.24},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":48761.38},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":43530.03},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":51719.07},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":59927.3},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":53347.08},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":50003.7}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15587.56,"10th_percentile":15587.56,"90th_percentile":15587.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Permanent Cardiac Pacemaker Implant Without Cc/Mcc","code_information":[{"code":"244","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":36923.61,"maximum":74783.51,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":74783.51},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":40130.12},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":41361.02},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":36923.61},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":43869.83},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":50832.32},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":45250.76},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":42414.8}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Aicd Generator Procedures","code_information":[{"code":"245","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":93200.71,"maximum":188764.74,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":188764.74},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":101294.4},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":104401.4},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":93200.71},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":110734.01},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":128308.38},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":114219.68},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":107061.28}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Percutaneous Cardiovascular Procedures Without Intraluminal Device With Mcc","code_information":[{"code":"250","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":44584.11,"maximum":90298.76,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":90298.76},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":48455.87},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":49942.15},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":44584.11},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":52971.46},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":61378.45},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":54638.89},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":51214.55}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Percutaneous Cardiovascular Procedures Without Intraluminal Device Without Mcc","code_information":[{"code":"251","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":30529.65,"maximum":61833.44,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":61833.44},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":33180.89},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":34198.64},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":30529.65},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":36273.01},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":42029.82},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37414.81},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35069.94}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Vascular Procedures With Mcc","code_information":[{"code":"252","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":71258.99,"maximum":144324.92,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":144324.92},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":77447.24},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":79822.77},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":71258.99},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":84664.53},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":98101.46},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":87329.59},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":81856.45}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Vascular Procedures With Cc","code_information":[{"code":"253","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":53022.92,"maximum":107390.35,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":107390.35},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":57627.51},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":59395.11},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":53022.92},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":62997.81},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":72996.06},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":64980.85},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":60908.35}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":70109.01,"10th_percentile":70109.01,"90th_percentile":70109.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":17774.39,"10th_percentile":17774.39,"90th_percentile":17774.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"1 through 10","median_amount":64980.85,"10th_percentile":64980.85,"90th_percentile":64980.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":19416.3,"10th_percentile":19416.3,"90th_percentile":19416.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Vascular Procedures Without Cc/Mcc","code_information":[{"code":"254","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":36396.57,"maximum":73716.06,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":73716.06},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":39557.3},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":40770.64},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":36396.57},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":43243.64},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":50106.75},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":44604.86},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":41809.37}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Upper Limb And Toe Amputation For Circulatory System Disorders With Mcc","code_information":[{"code":"255","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":55102.49,"maximum":111602.23,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":111602.23},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":59887.67},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":61724.6},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":55102.49},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":65468.6},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":75858.98},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":67529.41},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":63297.19}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Upper Limb And Toe Amputation For Circulatory System Disorders With Cc","code_information":[{"code":"256","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":34684.7,"maximum":70248.91,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":70248.91},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":37696.78},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":38853.05},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":34684.7},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":41209.73},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":47750.04},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":42506.93},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":39842.92}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Upper Limb And Toe Amputation For Circulatory System Disorders Without Cc/Mcc","code_information":[{"code":"257","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":22311.46,"maximum":45188.68,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":45188.68},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":24249.02},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":24992.81},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":22311.46},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":26508.79},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":30715.94},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27343.23},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25629.57}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Pacemaker Device Replacement With Mcc","code_information":[{"code":"258","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":64186.82,"maximum":130001.25,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":130001.25},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":69760.9},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":71900.67},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":64186.82},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":76261.91},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":88365.28},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":78662.47},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":73732.52}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Pacemaker Device Replacement Without Mcc","code_information":[{"code":"259","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":41307.46,"maximum":83662.37,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":83662.37},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":44894.66},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":46271.71},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":41307.46},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":49078.39},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":56867.52},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":50623.27},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":47450.6}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Pacemaker Revision Except Device Replacement With Mcc","code_information":[{"code":"260","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":66448.2,"maximum":134581.35,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":134581.35},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":72218.67},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":74433.82},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":66448.2},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":78948.71},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":91478.49},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":81433.85},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":76330.2}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Pacemaker Revision Except Device Replacement With Cc","code_information":[{"code":"261","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":38619.13,"maximum":78217.55,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":78217.55},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":41972.88},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":43260.31},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":38619.13},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":45884.33},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":53166.53},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":47328.67},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":44362.47}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Pacemaker Revision Except Device Replacement Without Cc/Mcc","code_information":[{"code":"262","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":33295.6,"maximum":67435.48,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":67435.48},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":36187.04},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":37297.0},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":33295.6},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":39559.3},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":45837.68},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":40804.55},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":38247.23}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Vein Ligation And Stripping","code_information":[{"code":"263","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":62456.57,"maximum":126496.87,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":126496.87},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":67880.39},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":69962.48},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":62456.57},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":74206.16},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":85983.26},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":76542.01},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":71744.95}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Circulatory System O.R. Procedures","code_information":[{"code":"264","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":68241.78,"maximum":138213.98,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":138213.98},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":74168.0},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":76442.95},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":68241.78},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":81079.7},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":93947.69},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":83631.92},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":78390.52}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Aicd Lead Procedures","code_information":[{"code":"265","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":73912.59,"maximum":149699.41,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":149699.41},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":80331.28},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":82795.27},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":73912.59},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":87817.33},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":101754.64},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":90581.64},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":84904.68}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Endovascular Cardiac Valve Replacement And Supplement Procedures With Mcc","code_information":[{"code":"266","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":125190.96,"maximum":253556.42,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":253556.42},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":136062.74},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":140236.18},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":125190.96},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":148742.4},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":172348.99},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":153424.49},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":143809.03}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Endovascular Cardiac Valve Replacement And Supplement Procedures Without Mcc","code_information":[{"code":"267","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":97253.62,"maximum":196973.34,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":196973.34},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":105699.28},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":108941.39},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":97253.62},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":115549.38},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":133887.98},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":119186.63},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":111716.93}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Aortic And Heart Assist Procedures Except Pulsation Balloon With Mcc","code_information":[{"code":"268","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":140501.74,"maximum":284566.23,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":284566.23},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":152703.14},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":157386.99},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":140501.74},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":166933.51},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":193427.18},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":172188.23},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":161396.8}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Aortic And Heart Assist Procedures Except Pulsation Balloon Without Mcc","code_information":[{"code":"269","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":86271.53,"maximum":174730.68,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":174730.68},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":93763.49},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":96639.49},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":86271.53},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":102501.29},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":118769.05},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":105727.81},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":99101.61}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Major Cardiovascular Procedures With Mcc","code_information":[{"code":"270","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":107784.26,"maximum":218301.64,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":218301.64},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":117144.41},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":120737.57},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":107784.26},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":128061.08},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":148385.38},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":132092.17},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":123813.66}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":36446.24,"10th_percentile":36446.24,"90th_percentile":36446.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Major Cardiovascular Procedures With Cc","code_information":[{"code":"271","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":72648.1,"maximum":147138.36,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":147138.36},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":78956.97},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":81378.81},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":72648.1},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":86314.96},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":100013.82},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":89031.97},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":83452.14}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"1 through 10","median_amount":4144.27,"10th_percentile":4144.27,"90th_percentile":4144.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":24353.16,"10th_percentile":24353.16,"90th_percentile":24353.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":26977.71,"10th_percentile":26977.71,"90th_percentile":26977.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Major Cardiovascular Procedures Without Cc/Mcc","code_information":[{"code":"272","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":52152.68,"maximum":105627.82,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":105627.82},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":56681.71},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":58420.3},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":52152.68},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":61963.86},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":71798.02},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":63914.36},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":59908.7}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Percutaneous And Other Intracardiac Procedures With Mcc","code_information":[{"code":"273","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":84275.71,"maximum":170688.44,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":170688.44},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":91594.35},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":94403.82},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":84275.71},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":100130.01},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":116021.44},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":103281.89},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":96808.98}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Percutaneous And Other Intracardiac Procedures Without Mcc","code_information":[{"code":"274","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":67242.85,"maximum":136190.8,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":136190.8},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":73082.32},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":75323.97},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":67242.85},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":79892.85},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":92572.48},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":82407.71},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":77243.03}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Defibrillator Implant With Cardiac Catheterization And Mcc","code_information":[{"code":"275","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":145659.81,"maximum":295013.17,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":295013.17},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":158309.14},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":163164.94},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":145659.81},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":173061.94},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":200528.24},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":178509.56},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":167321.97}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Defibrillator Implant With Mcc Or Carotid Sinus Neurostimulator","code_information":[{"code":"276","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":122702.82,"maximum":248517.07,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":248517.07},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":133358.53},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":137449.03},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":122702.82},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":145786.19},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":168923.61},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":150375.23},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":140950.88}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Defibrillator Implant Without Mcc","code_information":[{"code":"277","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":94346.72,"maximum":191085.82,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":191085.82},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":102539.94},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":105685.14},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":94346.72},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":112095.61},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":129886.08},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":115624.15},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":108377.72}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7071.76,"10th_percentile":7071.76,"90th_percentile":7071.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ultrasound Accelerated And Other Thrombolysis Of Peripheral Vascular Structures With Mcc","code_information":[{"code":"278","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":113706.33,"maximum":230295.96,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":230295.96},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":123580.77},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":127371.35},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":113706.33},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":135097.24},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":156538.24},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":139349.82},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":130616.45}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ultrasound Accelerated And Other Thrombolysis Of Peripheral Vascular Structures Without Mcc","code_information":[{"code":"279","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":73671.54,"maximum":149211.19,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":149211.19},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":80069.29},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":82525.25},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":73671.54},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":87530.93},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":101422.79},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":90286.22},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":84627.78}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute Myocardial Infarction, Discharged Alive With Mcc","code_information":[{"code":"280","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":32768.55,"maximum":66368.03,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":66368.03},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":35614.23},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":36706.62},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":32768.55},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":38933.11},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":45112.1},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":40158.64},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37641.81}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":20381.97,"10th_percentile":20381.97,"90th_percentile":20381.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10985.7,"10th_percentile":10985.7,"90th_percentile":10985.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11574.42,"10th_percentile":11574.42,"90th_percentile":11574.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute Myocardial Infarction, Discharged Alive With Cc","code_information":[{"code":"281","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":18775.37,"maximum":38026.84,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":38026.84},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":20405.86},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":21031.77},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":18775.37},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":22307.48},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":25847.85},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23009.67},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21567.6}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute Myocardial Infarction, Discharged Alive Without Cc/Mcc","code_information":[{"code":"282","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14771.49,"maximum":29917.54,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29917.54},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":16054.27},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":16546.7},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":14771.49},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":17550.36},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":20335.74},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18102.81},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16968.26}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12130.28,"10th_percentile":12130.28,"90th_percentile":12130.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute Myocardial Infarction, Expired With Mcc","code_information":[{"code":"283","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":40463.78,"maximum":81953.62,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":81953.62},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":43977.72},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":45326.65},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":40463.78},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":48076.0},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":55706.04},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":49589.33},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":46481.45}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute Myocardial Infarction, Expired With Cc","code_information":[{"code":"284","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14140.26,"maximum":28639.08,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28639.08},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":15368.22},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":15839.61},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":14140.26},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":16800.39},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":19466.74},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17329.23},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16243.17}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute Myocardial Infarction, Expired Without Cc/Mcc","code_information":[{"code":"285","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12234.33,"maximum":24778.89,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24778.89},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":13296.78},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":13704.63},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":12234.33},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":14535.9},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":16842.86},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14993.46},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14053.79}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Circulatory Disorders Except Ami, With Cardiac Catheterization With Mcc","code_information":[{"code":"286","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":45203.08,"maximum":91552.39,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":91552.39},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":49128.59},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":50635.5},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":45203.08},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":53706.87},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":62230.57},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":55397.45},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":51925.56}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15153.02,"10th_percentile":15153.02,"90th_percentile":15153.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":4738.0,"10th_percentile":4738.0,"90th_percentile":4738.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14677.32,"10th_percentile":14677.32,"90th_percentile":14677.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Circulatory Disorders Except Ami, With Cardiac Catheterization Without Mcc","code_information":[{"code":"287","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":21860.0,"maximum":44274.32,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":44274.32},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":23758.36},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":24487.1},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":21860.0},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":25972.4},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":30094.42},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26789.95},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25110.97}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"1 through 10","median_amount":25972.4,"10th_percentile":25972.4,"90th_percentile":25972.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7481.97,"10th_percentile":7481.97,"90th_percentile":7481.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"1 through 10","median_amount":5336.84,"10th_percentile":5336.84,"90th_percentile":5336.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6561.35,"10th_percentile":6561.35,"90th_percentile":6561.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute And Subacute Endocarditis With Mcc","code_information":[{"code":"288","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":55282.25,"maximum":111966.32,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":111966.32},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":60083.05},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":61925.97},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":55282.25},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":65682.18},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":76106.46},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":67749.72},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":63503.69}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute And Subacute Endocarditis With Cc","code_information":[{"code":"289","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":34868.55,"maximum":70621.28,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":70621.28},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":37896.59},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":39058.99},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":34868.55},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":41428.17},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":48003.15},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":42732.24},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":40054.12}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute And Subacute Endocarditis Without Cc/Mcc","code_information":[{"code":"290","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":18991.91,"maximum":38465.41,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":38465.41},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":20641.2},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":21274.33},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":18991.91},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":22564.75},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":26145.95},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23275.04},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21816.34}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Heart Failure And Shock With Mcc","code_information":[{"code":"291","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":26225.47,"maximum":53115.94,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":53115.94},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":28502.93},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":29377.2},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":26225.47},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":31159.11},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":36104.31},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32139.93},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30125.65}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10968.57,"10th_percentile":10968.57,"90th_percentile":10968.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"1 through 10","median_amount":26660.19,"10th_percentile":26660.19,"90th_percentile":26660.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9608.75,"10th_percentile":9389.7,"90th_percentile":10741.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":20227.11,"10th_percentile":20227.11,"90th_percentile":20227.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Heart Failure And Shock With Cc","code_information":[{"code":"292","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17343.37,"maximum":35126.53,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35126.53},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":18849.5},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":19427.67},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":17343.37},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":20606.08},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":23876.43},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21254.72},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19922.63}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7470.2,"10th_percentile":7470.2,"90th_percentile":7470.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Heart Failure And Shock Without Cc/Mcc","code_information":[{"code":"293","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11562.25,"maximum":23417.68,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23417.68},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":12566.33},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":12951.78},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":11562.25},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":13737.39},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":15917.62},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14169.81},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13281.76}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Arrest, Unexplained With Mcc","code_information":[{"code":"296","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":31906.49,"maximum":64622.05,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":64622.05},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":34677.3},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":35740.96},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":31906.49},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":37908.87},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":43925.31},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":39102.17},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":36651.55}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Arrest, Unexplained With Cc","code_information":[{"code":"297","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12951.35,"maximum":26231.12,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26231.12},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":14076.07},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":14507.82},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":12951.35},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":15387.81},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":17829.98},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15872.19},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14877.44}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Arrest, Unexplained Without Cc/Mcc","code_information":[{"code":"298","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9296.78,"maximum":18829.31,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18829.31},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":10104.13},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":10414.05},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":9296.78},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":11045.73},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":12798.78},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11393.43},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10679.38}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Peripheral Vascular Disorders With Mcc","code_information":[{"code":"299","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":33352.8,"maximum":67551.33,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":67551.33},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":36249.21},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":37361.07},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":33352.8},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":39627.26},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":45916.42},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":40874.64},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":38312.94}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":28664.09,"10th_percentile":28664.09,"90th_percentile":28664.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6197.13,"10th_percentile":6197.13,"90th_percentile":6197.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Peripheral Vascular Disorders With Cc","code_information":[{"code":"300","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":21806.89,"maximum":44166.75,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":44166.75},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":23700.64},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":24427.6},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":21806.89},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":25909.29},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":30021.3},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26724.86},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25049.96}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"1 through 10","median_amount":21806.89,"10th_percentile":21806.89,"90th_percentile":21806.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Peripheral Vascular Disorders Without Cc/Mcc","code_information":[{"code":"301","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14702.03,"maximum":29776.87,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29776.87},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":15978.78},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":16468.9},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":14702.03},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":17467.84},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":20240.12},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18017.69},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16888.48}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Atherosclerosis With Mcc","code_information":[{"code":"302","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":24444.14,"maximum":49508.13,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":49508.13},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":26566.91},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":27381.8},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":24444.14},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":29042.68},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":33651.98},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29956.88},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28079.42}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Atherosclerosis Without Mcc","code_information":[{"code":"303","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13752.13,"maximum":27852.98,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27852.98},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":14946.39},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":15404.84},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":13752.13},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":16339.24},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":18932.4},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16853.56},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15797.31}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hypertension With Mcc","code_information":[{"code":"304","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":24309.32,"maximum":49235.06,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":49235.06},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":26420.38},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":27230.77},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":24309.32},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":28882.49},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":33466.37},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29791.65},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27924.54}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hypertension Without Mcc","code_information":[{"code":"305","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15425.18,"maximum":31241.51,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31241.51},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":16764.73},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":17278.95},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":15425.18},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":18327.03},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":21235.68},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18903.93},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17719.18}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5585.72,"10th_percentile":5585.72,"90th_percentile":5585.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12108.44,"10th_percentile":12108.44,"90th_percentile":12108.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":4199.01,"10th_percentile":4199.01,"90th_percentile":4199.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Congenital And Valvular Disorders With Mcc","code_information":[{"code":"306","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":32190.44,"maximum":65197.15,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":65197.15},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":34985.91},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":36059.03},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":32190.44},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":38246.24},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":44316.22},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":39450.15},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":36977.72}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Congenital And Valvular Disorders Without Mcc","code_information":[{"code":"307","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":18654.85,"maximum":37782.74,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37782.74},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":20274.87},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":20896.76},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":18654.85},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":22164.28},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":25681.92},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22861.96},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21429.15}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Arrhythmia And Conduction Disorders With Mcc","code_information":[{"code":"308","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":24595.31,"maximum":49814.3,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":49814.3},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":26731.21},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":27551.13},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":24595.31},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":29222.28},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":33860.09},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30142.14},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28253.06}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"1 through 10","median_amount":1713.21,"10th_percentile":1713.21,"90th_percentile":1713.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Arrhythmia And Conduction Disorders With Cc","code_information":[{"code":"309","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15028.88,"maximum":30438.85,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30438.85},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":16334.01},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":16835.02},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":15028.88},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":17856.17},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":20690.09},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18418.25},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17263.94}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5454.22,"10th_percentile":5454.22,"90th_percentile":5454.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":4060.92,"10th_percentile":4060.92,"90th_percentile":4060.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Arrhythmia And Conduction Disorders Without Cc/Mcc","code_information":[{"code":"310","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11564.29,"maximum":23421.82,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23421.82},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":12568.55},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":12954.07},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":11564.29},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":13739.81},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":15920.43},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14172.31},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13284.1}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":4070.99,"10th_percentile":4070.99,"90th_percentile":4070.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Angina Pectoris","code_information":[{"code":"311","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14338.41,"maximum":29040.41,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29040.41},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":15583.58},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":16061.58},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":14338.41},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":17035.81},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":19739.53},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17572.07},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16470.79}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Syncope And Collapse","code_information":[{"code":"312","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17805.04,"maximum":36061.58,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":36061.58},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":19351.26},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":19944.82},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":17805.04},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":21154.6},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":24512.01},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21820.51},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20452.97}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6366.44,"10th_percentile":6366.44,"90th_percentile":6366.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7662.55,"10th_percentile":7662.55,"90th_percentile":7662.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Chest Pain","code_information":[{"code":"313","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14708.16,"maximum":29789.28,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29789.28},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":15985.44},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":16475.76},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":14708.16},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":17475.12},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":20248.56},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18025.2},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16895.52}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"1 through 10","median_amount":17109.14,"10th_percentile":17109.14,"90th_percentile":17109.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5353.79,"10th_percentile":5353.79,"90th_percentile":6466.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11569.46,"10th_percentile":11569.46,"90th_percentile":11569.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Circulatory System Diagnoses With Mcc","code_information":[{"code":"314","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":42596.47,"maximum":86273.06,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":86273.06},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":46295.61},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":47715.63},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":42596.47},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":50609.89},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":58642.08},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":52202.98},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":48931.3}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14588.1,"10th_percentile":14588.1,"90th_percentile":14588.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Circulatory System Diagnoses With Cc","code_information":[{"code":"315","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":19678.29,"maximum":39855.57,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":39855.57},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":21387.19},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":22043.19},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":19678.29},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":23380.25},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":27090.89},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24116.22},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22604.8}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6596.58,"10th_percentile":6596.58,"90th_percentile":6596.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7214.11,"10th_percentile":7214.11,"90th_percentile":7214.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Circulatory System Diagnoses Without Cc/Mcc","code_information":[{"code":"316","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13933.94,"maximum":28221.21,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28221.21},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":15143.98},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":15608.49},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":13933.94},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":16555.25},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":19182.7},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17076.37},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16006.16}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Concomitant Left Atrial Appendage Closure And Cardiac Ablation","code_information":[{"code":"317","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":136591.82,"maximum":276647.25,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":276647.25},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":148453.67},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":153007.18},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":136591.82},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":162288.04},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":188044.44},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":167396.53},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":156905.41}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Percutaneous Coronary Atherectomy Without Intraluminal Device","code_information":[{"code":"318","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":49480.7,"maximum":100216.1,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":100216.1},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":53777.68},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":55427.2},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":49480.7},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":58789.22},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":68119.53},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":60639.78},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":56839.35}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Endovascular Cardiac Valve Procedures With Mcc","code_information":[{"code":"319","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":91168.12,"maximum":184648.02,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":184648.02},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":99085.31},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":102124.54},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":91168.12},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":108319.05},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":125510.14},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":111728.7},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":104726.41}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Endovascular Cardiac Valve Procedures Without Mcc","code_information":[{"code":"320","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":49135.47,"maximum":99516.88,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":99516.88},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":53402.47},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":55040.48},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":49135.47},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":58379.04},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":67644.25},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":60216.69},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":56442.77}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Percutaneous Cardiovascular Procedures With Intraluminal Device With Mcc Or 4+ Arteries/Intraluminal","code_information":[{"code":"321","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":55580.5,"maximum":112570.38,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":112570.38},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":60407.2},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":62260.07},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":55580.5},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":66036.54},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":76517.06},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":68115.23},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":63846.29}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Percutaneous Cardiovascular Procedures With Intraluminal Device Without Mcc","code_information":[{"code":"322","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":36014.56,"maximum":72942.36,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":72942.36},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":39142.13},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":40342.73},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":36014.56},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":42789.77},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":49580.85},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":44136.71},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":41370.56}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"1 through 10","median_amount":69469.25,"10th_percentile":69469.25,"90th_percentile":69469.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13091.17,"10th_percentile":13091.17,"90th_percentile":13091.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Coronary Intravascular Lithotripsy With Intraluminal Device With Mcc","code_information":[{"code":"323","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":88400.13,"maximum":179041.85,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":179041.85},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":96076.93},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":99023.89},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":88400.13},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":105030.33},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":121699.47},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":108336.46},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":101546.77}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Coronary Intravascular Lithotripsy With Intraluminal Device Without Mcc","code_information":[{"code":"324","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":64368.63,"maximum":130369.47,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":130369.47},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":69958.5},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":72104.33},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":64368.63},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":76477.92},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":88615.57},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":78885.29},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":73941.37}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Coronary Intravascular Lithotripsy Without Intraluminal Device","code_information":[{"code":"325","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":65582.05,"maximum":132827.09,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":132827.09},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":71277.3},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":73463.58},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":65582.05},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":77919.62},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":90286.08},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":80372.36},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":75335.25}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Stomach, Esophageal And Duodenal Procedures With Mcc","code_information":[{"code":"326","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":101882.61,"maximum":206348.69,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":206348.69},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":110730.25},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":114126.67},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":101882.61},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":121049.19},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":140260.65},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":124859.56},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":117034.33}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Stomach, Esophageal And Duodenal Procedures With Cc","code_information":[{"code":"327","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":49930.12,"maximum":101126.33,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":101126.33},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":54266.13},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":55930.63},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":49930.12},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":59323.18},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":68738.24},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":61190.55},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":57355.6}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Stomach, Esophageal And Duodenal Procedures Without Cc/Mcc","code_information":[{"code":"328","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":32731.78,"maximum":66293.56,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":66293.56},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":35574.26},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":36665.43},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":32731.78},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":38889.42},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":45061.48},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":40113.58},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37599.57}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Small And Large Bowel Procedures With Mcc","code_information":[{"code":"329","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":93897.3,"maximum":190175.59,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":190175.59},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":102051.49},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":105181.71},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":93897.3},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":111561.65},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":129267.37},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":115073.38},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":107861.47}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":73662.62,"10th_percentile":73662.62,"90th_percentile":73662.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Small And Large Bowel Procedures With Cc","code_information":[{"code":"330","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":48970.0,"maximum":99181.75,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":99181.75},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":53222.63},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":54855.13},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":48970.0},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":58182.44},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":67416.46},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":60013.9},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":56252.7}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":18817.89,"10th_percentile":18817.89,"90th_percentile":18817.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13673.48,"10th_percentile":13673.48,"90th_percentile":13673.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Small And Large Bowel Procedures Without Cc/Mcc","code_information":[{"code":"331","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":34378.28,"maximum":69628.3,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":69628.3},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":37363.75},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":38509.8},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":34378.28},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":40845.67},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":47328.2},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":42131.4},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":39490.93}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"1 through 10","median_amount":45901.61,"10th_percentile":45901.61,"90th_percentile":45901.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Rectal Resection With Mcc","code_information":[{"code":"332","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":73963.66,"maximum":149802.84,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":149802.84},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":80386.78},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":82852.48},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":73963.66},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":87878.01},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":101824.95},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":90644.22},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":84963.35}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Rectal Resection With Cc","code_information":[{"code":"333","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":47846.46,"maximum":96906.18,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":96906.18},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":52001.52},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":53596.56},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":47846.46},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":56847.54},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":65869.69},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":58636.98},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":54962.07}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Rectal Resection Without Cc/Mcc","code_information":[{"code":"334","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":33459.02,"maximum":67766.47,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":67766.47},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":36364.66},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":37480.07},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":33459.02},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":39753.47},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":46062.66},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":41004.83},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":38434.96}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Peritoneal Adhesiolysis With Mcc","code_information":[{"code":"335","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":72946.35,"maximum":147742.42,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":147742.42},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":79281.12},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":81712.9},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":72946.35},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":86669.31},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":100424.42},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":89397.48},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":83794.74}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Peritoneal Adhesiolysis With Cc","code_information":[{"code":"336","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":43076.52,"maximum":87245.35,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":87245.35},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":46817.36},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":48253.38},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":43076.52},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":51180.26},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":59302.97},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":52791.3},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":49482.75}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Peritoneal Adhesiolysis Without Cc/Mcc","code_information":[{"code":"337","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":31356.98,"maximum":63509.09,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":63509.09},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":34080.07},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":35125.41},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":31356.98},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":37255.99},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":43168.81},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":38428.73},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":36020.31}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"1 through 10","median_amount":60485.14,"10th_percentile":60485.14,"90th_percentile":60485.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Minor Small And Large Bowel Procedures With Mcc","code_information":[{"code":"344","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":52761.44,"maximum":106860.77,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":106860.77},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":57343.33},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":59102.21},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":52761.44},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":62687.14},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":72636.08},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":64660.4},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":60607.98}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Minor Small And Large Bowel Procedures With Cc","code_information":[{"code":"345","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":30738.01,"maximum":62255.46,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":62255.46},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":33407.35},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":34432.05},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":30738.01},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":36520.57},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":42316.68},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37670.16},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35309.29}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Minor Small And Large Bowel Procedures Without Cc/Mcc","code_information":[{"code":"346","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":24231.69,"maximum":49077.84,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":49077.84},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":26336.01},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":27143.81},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":24231.69},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":28790.26},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":33359.5},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29696.52},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27835.37}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Anal And Stomal Procedures With Mcc","code_information":[{"code":"347","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":46894.52,"maximum":94978.15,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":94978.15},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":50966.91},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":52530.21},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":46894.52},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":55716.51},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":64559.16},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":57470.35},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":53868.55}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Anal And Stomal Procedures With Cc","code_information":[{"code":"348","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":26736.17,"maximum":54150.29,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":54150.29},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":29057.98},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":29949.27},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":26736.17},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":31765.88},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":36807.38},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32765.81},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30712.3}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Anal And Stomal Procedures Without Cc/Mcc","code_information":[{"code":"349","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17784.62,"maximum":36020.2,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":36020.2},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":19329.06},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":19921.94},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":17784.62},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":21130.33},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":24483.88},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21795.47},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20429.5}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Inguinal And Femoral Hernia Procedures With Mcc","code_information":[{"code":"350","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":50904.53,"maximum":103099.87,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":103099.87},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":55325.16},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":57022.15},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":50904.53},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":60480.9},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":70079.7},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":62384.72},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":58474.93}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Inguinal And Femoral Hernia Procedures With Cc","code_information":[{"code":"351","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":31142.49,"maximum":63074.66,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":63074.66},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":33846.95},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":34885.13},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":31142.49},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":37001.14},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":42873.51},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":38165.86},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35773.92}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9908.75,"10th_percentile":9908.75,"90th_percentile":9908.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Inguinal And Femoral Hernia Procedures Without Cc/Mcc","code_information":[{"code":"352","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":23855.82,"maximum":48316.56,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":48316.56},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":25927.5},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":26722.77},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":23855.82},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":28343.67},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":32842.04},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29235.87},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27403.59}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hernia Procedures Except Inguinal And Femoral With Mcc","code_information":[{"code":"353","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":59282.06,"maximum":120067.35,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":120067.35},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":64430.2},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":66406.47},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":59282.06},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":70434.44},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":81612.95},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":72651.57},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":68098.33}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hernia Procedures Except Inguinal And Femoral With Cc","code_information":[{"code":"354","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":34368.07,"maximum":69607.62,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":69607.62},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":37352.64},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":38498.36},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":34368.07},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":40833.53},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":47314.14},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":42118.88},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":39479.2}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12105.19,"10th_percentile":12105.19,"90th_percentile":12105.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hernia Procedures Except Inguinal And Femoral Without Cc/Mcc","code_information":[{"code":"355","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":27475.66,"maximum":55648.03,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":55648.03},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":29861.69},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":30777.64},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":27475.66},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":32644.5},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":37825.44},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33672.08},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31561.77}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Digestive System O.R. Procedures With Mcc","code_information":[{"code":"356","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":89736.12,"maximum":181747.71,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":181747.71},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":97528.95},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":100520.44},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":89736.12},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":106617.65},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":123538.71},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":109973.75},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":103081.44}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":34102.14,"10th_percentile":34102.14,"90th_percentile":34102.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Digestive System O.R. Procedures With Cc","code_information":[{"code":"357","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":47505.31,"maximum":96215.24,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":96215.24},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":51630.75},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":53214.42},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":47505.31},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":56442.21},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":65400.04},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":58218.89},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":54570.18}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Digestive System O.R. Procedures Without Cc/Mcc","code_information":[{"code":"358","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":28556.3,"maximum":57836.71,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":57836.71},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":31036.18},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":31988.15},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":28556.3},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":33928.43},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":39313.14},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34996.43},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32803.12}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Percutaneous Coronary Atherectomy With Intraluminal Device With Mcc","code_information":[{"code":"359","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":70243.72,"maximum":142268.64,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":142268.64},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":76343.8},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":78685.48},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":70243.72},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":83458.26},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":96703.75},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":86085.35},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":80690.19}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Percutaneous Coronary Atherectomy With Intraluminal Device Without Mcc","code_information":[{"code":"360","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":49319.32,"maximum":99889.25,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":99889.25},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":53602.29},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":55246.43},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":49319.32},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":58597.48},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":67897.36},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":60442.0},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":56653.96}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Esophageal Disorders With Mcc","code_information":[{"code":"368","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":32519.33,"maximum":65863.27,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":65863.27},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":35343.36},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":36427.45},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":32519.33},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":38637.0},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":44769.0},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":39853.22},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37355.53}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Esophageal Disorders With Cc","code_information":[{"code":"369","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":20432.09,"maximum":41382.27,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":41382.27},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":22206.44},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":22887.58},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":20432.09},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":24275.85},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":28128.62},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25040.01},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23470.69}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"1 through 10","median_amount":22387.58,"10th_percentile":22387.58,"90th_percentile":22387.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7253.19,"10th_percentile":7253.19,"90th_percentile":7253.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Esophageal Disorders Without Cc/Mcc","code_information":[{"code":"370","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14315.94,"maximum":28994.9,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28994.9},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":15559.16},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":16036.41},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":14315.94},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":17009.12},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":19708.6},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17544.53},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16444.97}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Gastrointestinal Disorders And Peritoneal Infections With Mcc","code_information":[{"code":"371","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":36220.89,"maximum":73360.24,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":73360.24},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":39366.37},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":40573.85},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":36220.89},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":43034.91},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":49864.89},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":44389.56},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":41607.56}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Gastrointestinal Disorders And Peritoneal Infections With Cc","code_information":[{"code":"372","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":20856.99,"maximum":42242.85,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":42242.85},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":22668.24},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":23363.54},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":20856.99},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":24780.69},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":28713.58},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25560.74},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23958.79}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Gastrointestinal Disorders And Peritoneal Infections Without Cc/Mcc","code_information":[{"code":"373","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14859.33,"maximum":30095.45,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30095.45},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":16149.73},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":16645.09},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":14859.33},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":17654.73},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":20456.67},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18210.46},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17069.17}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Digestive Malignancy With Mcc","code_information":[{"code":"374","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":43689.36,"maximum":88486.57,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":88486.57},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":47483.42},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":48939.87},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":43689.36},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":51908.39},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":60146.66},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":53542.35},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":50186.73}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Digestive Malignancy With Cc","code_information":[{"code":"375","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":24709.71,"maximum":50045.99,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":50045.99},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":26855.54},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":27679.28},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":24709.71},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":29358.2},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":34017.58},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30282.34},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28384.47}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Digestive Malignancy Without Cc/Mcc","code_information":[{"code":"376","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":18881.6,"maximum":38241.99,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":38241.99},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":20521.31},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":21150.76},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":18881.6},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":22433.69},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":25994.09},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23139.85},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21689.62}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Gastrointestinal Hemorrhage With Mcc","code_information":[{"code":"377","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":37342.38,"maximum":75631.67,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":75631.67},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":40585.26},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":41830.12},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":37342.38},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":44367.39},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":51408.84},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":45763.98},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":42895.85}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Gastrointestinal Hemorrhage With Cc","code_information":[{"code":"378","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":20033.74,"maximum":40575.48,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":40575.48},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":21773.5},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":22441.36},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":20033.74},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":23802.57},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":27580.23},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24551.82},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23013.11}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7155.03,"10th_percentile":7155.03,"90th_percentile":7155.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":3127.98,"10th_percentile":3127.98,"90th_percentile":3127.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16599.16,"10th_percentile":16599.16,"90th_percentile":16599.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Gastrointestinal Hemorrhage Without Cc/Mcc","code_information":[{"code":"379","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12877.81,"maximum":26082.17,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26082.17},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":13996.14},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":14425.44},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":12877.81},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":15300.44},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":17728.74},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15782.06},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14792.97}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Complicated Peptic Ulcer With Mcc","code_information":[{"code":"380","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":40083.82,"maximum":81184.06,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":81184.06},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":43564.76},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":44901.02},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":40083.82},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":47624.56},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":55182.95},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":49123.68},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":46044.99}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Complicated Peptic Ulcer With Cc","code_information":[{"code":"381","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":22133.74,"maximum":44828.73,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":44828.73},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":24055.87},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":24793.73},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":22133.74},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":26297.63},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":30471.27},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27125.42},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25425.41}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Complicated Peptic Ulcer Without Cc/Mcc","code_information":[{"code":"382","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16354.66,"maximum":33124.02,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33124.02},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":17774.92},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":18320.13},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":16354.66},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":19431.36},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":22515.27},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20043.02},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18786.88}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Uncomplicated Peptic Ulcer With Mcc","code_information":[{"code":"383","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":28204.94,"maximum":57125.08,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":57125.08},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":30654.3},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":31594.56},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":28204.94},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":33510.97},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":38829.43},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34565.82},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32399.51}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Uncomplicated Peptic Ulcer Without Mcc","code_information":[{"code":"384","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17461.85,"maximum":35366.5,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35366.5},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":18978.27},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":19560.39},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":17461.85},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":20746.85},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":24039.54},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21399.92},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20058.74}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Inflammatory Bowel Disease With Mcc","code_information":[{"code":"385","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":32323.22,"maximum":65466.08,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":65466.08},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":35130.22},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":36207.77},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":32323.22},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":38404.0},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":44499.02},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":39612.88},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37130.25}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Inflammatory Bowel Disease With Cc","code_information":[{"code":"386","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":19943.86,"maximum":40393.44,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":40393.44},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":21675.81},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":22340.67},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":19943.86},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":23695.78},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":27456.48},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24441.67},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22909.86}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"1 through 10","median_amount":27456.48,"10th_percentile":27456.48,"90th_percentile":27456.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7534.29,"10th_percentile":7534.29,"90th_percentile":7534.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"1 through 10","median_amount":4936.88,"10th_percentile":4936.88,"90th_percentile":4936.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Inflammatory Bowel Disease Without Cc/Mcc","code_information":[{"code":"387","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13917.6,"maximum":28188.11,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28188.11},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":15126.22},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":15590.19},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":13917.6},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":16535.83},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":19160.2},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17056.35},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15987.39}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Gastrointestinal Obstruction With Mcc","code_information":[{"code":"388","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":30168.07,"maximum":61101.12,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":61101.12},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":32787.91},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":33793.61},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":30168.07},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":35843.41},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":41532.05},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":36971.69},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34654.59}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Gastrointestinal Obstruction With Cc","code_information":[{"code":"389","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16134.03,"maximum":32677.19,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32677.19},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":17535.14},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":18072.99},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":16134.03},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":19169.24},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":22211.55},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19772.64},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18533.45}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"1 through 10","median_amount":28482.86,"10th_percentile":28482.86,"90th_percentile":28482.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"1 through 10","median_amount":5749.85,"10th_percentile":5749.85,"90th_percentile":5749.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Gastrointestinal Obstruction Without Cc/Mcc","code_information":[{"code":"390","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11112.83,"maximum":22507.46,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22507.46},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":12077.89},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":12448.35},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":11112.83},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":13203.42},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":15298.91},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13619.04},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12765.5}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":4149.03,"10th_percentile":4149.03,"90th_percentile":4149.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders With Mcc","code_information":[{"code":"391","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":25908.83,"maximum":52474.64,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":52474.64},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":28158.8},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":29022.51},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":25908.83},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":30782.91},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":35668.4},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31751.89},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29761.93}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10122.75,"10th_percentile":10122.75,"90th_percentile":10122.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"1 through 10","median_amount":35668.4,"10th_percentile":35668.4,"90th_percentile":35668.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"1 through 10","median_amount":31751.89,"10th_percentile":31751.89,"90th_percentile":31751.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6191.11,"10th_percentile":6191.11,"90th_percentile":6191.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders Without Mcc","code_information":[{"code":"392","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15925.67,"maximum":32255.17,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32255.17},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":17308.68},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":17839.59},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":15925.67},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":18921.67},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":21924.69},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19517.29},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18294.09}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"1 through 10","median_amount":19564.53,"10th_percentile":19564.53,"90th_percentile":19564.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7392.03,"10th_percentile":7392.03,"90th_percentile":7627.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"1 through 10","median_amount":18921.67,"10th_percentile":17308.68,"90th_percentile":20142.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":3072.12,"10th_percentile":3072.12,"90th_percentile":3072.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5513.75,"10th_percentile":5513.75,"90th_percentile":5513.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":3132.5,"10th_percentile":3132.5,"90th_percentile":3132.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12997.88,"10th_percentile":12997.88,"90th_percentile":12997.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7927.77,"10th_percentile":7927.77,"90th_percentile":7927.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Digestive System Diagnoses With Mcc","code_information":[{"code":"393","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":32670.5,"maximum":66169.44,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":66169.44},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":35507.66},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":36596.78},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":32670.5},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":38816.61},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":44977.11},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":40038.48},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37529.17}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Digestive System Diagnoses With Cc","code_information":[{"code":"394","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":19114.48,"maximum":38713.65,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":38713.65},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":20774.41},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":21411.62},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":19114.48},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":22710.37},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":26314.69},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23425.25},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21957.14}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Digestive System Diagnoses Without Cc/Mcc","code_information":[{"code":"395","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13257.77,"maximum":26851.73,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26851.73},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":14409.1},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":14851.07},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":13257.77},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":15751.88},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":18251.83},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16247.72},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15229.43}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Appendix Procedures With Mcc","code_information":[{"code":"397","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":48923.02,"maximum":99086.59,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":99086.59},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":53171.57},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":54802.5},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":48923.02},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":58126.62},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":67351.77},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":59956.32},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":56198.72}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Appendix Procedures With Cc","code_information":[{"code":"398","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":30919.82,"maximum":62623.69,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":62623.69},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":33604.95},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":34635.71},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":30919.82},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":36736.59},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":42566.97},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37892.98},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35518.14}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Appendix Procedures Without Cc/Mcc","code_information":[{"code":"399","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":23383.93,"maximum":47360.82,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":47360.82},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":25414.63},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":26194.17},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":23383.93},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":27783.01},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":32192.4},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28657.56},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26861.53}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7841.78,"10th_percentile":7841.78,"90th_percentile":7841.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"1 through 10","median_amount":27137.61,"10th_percentile":27137.61,"90th_percentile":28657.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Single Level Combined Anterior And Posterior Spinal Fusion Except Cervical","code_information":[{"code":"402","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":82130.77,"maximum":166344.17,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":166344.17},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":89263.14},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":92001.1},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":82130.77},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":97581.56},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":113068.52},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":100653.22},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":94345.05}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pancreas, Liver And Shunt Procedures With Mcc","code_information":[{"code":"405","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":111751.37,"maximum":226336.47,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":226336.47},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":121456.04},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":125181.45},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":111751.37},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":132774.51},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":153846.87},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":136953.97},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":128370.75}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pancreas, Liver And Shunt Procedures With Cc","code_information":[{"code":"406","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":59245.29,"maximum":119992.87,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":119992.87},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":64390.24},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":66365.28},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":59245.29},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":70390.75},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":81562.32},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":72606.51},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":68056.09}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pancreas, Liver And Shunt Procedures Without Cc/Mcc","code_information":[{"code":"407","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":45341.99,"maximum":91833.73,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":91833.73},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":49279.56},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":50791.11},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":45341.99},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":53871.91},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":62421.81},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":55567.69},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":52085.13}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With Mcc","code_information":[{"code":"408","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":72838.08,"maximum":147523.13,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":147523.13},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":79163.45},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":81591.62},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":72838.08},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":86540.68},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":100275.37},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":89264.8},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":83670.37}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With Cc","code_information":[{"code":"409","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":44477.88,"maximum":90083.61,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":90083.61},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":48340.41},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":49823.16},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":44477.88},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":52845.25},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":61232.21},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":54508.71},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":51092.52}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. Without Cc/Mcc","code_information":[{"code":"410","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":32433.54,"maximum":65689.5,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":65689.5},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":35250.12},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":36331.34},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":32433.54},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":38535.07},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":44650.89},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":39748.07},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37256.97}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cholecystectomy With C.D.E. With Mcc","code_information":[{"code":"411","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":67479.81,"maximum":136670.73,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":136670.73},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":73339.87},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":75589.41},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":67479.81},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":80174.39},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":92898.71},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":82698.12},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":77515.24}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cholecystectomy With C.D.E. With Cc","code_information":[{"code":"412","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":42949.87,"maximum":86988.84,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":86988.84},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":46679.71},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":48111.51},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":42949.87},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":51029.78},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":59128.61},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":52636.09},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":49337.27}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cholecystectomy With C.D.E. Without Cc/Mcc","code_information":[{"code":"413","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":33920.69,"maximum":68701.53,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":68701.53},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":36866.42},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":37997.22},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":33920.69},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":40302.0},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":46698.24},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":41570.62},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":38965.29}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cholecystectomy Except By Laparoscope Without C.D.E. With Mcc","code_information":[{"code":"414","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":72776.79,"maximum":147399.01,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":147399.01},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":79096.85},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":81522.98},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":72776.79},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":86467.86},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":100191.0},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":89189.69},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":83599.97}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cholecystectomy Except By Laparoscope Without C.D.E. With Cc","code_information":[{"code":"415","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":42218.55,"maximum":85507.65,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":85507.65},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":45884.87},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":47292.3},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":42218.55},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":50160.88},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":58121.8},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":51739.83},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":48497.18}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cholecystectomy Except By Laparoscope Without C.D.E. Without Cc/Mcc","code_information":[{"code":"416","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":27849.49,"maximum":56405.17,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":56405.17},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":30267.99},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":31196.39},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":27849.49},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":33088.65},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":38340.09},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34130.22},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31991.2}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Laparoscopic Cholecystectomy Without C.D.E. With Mcc","code_information":[{"code":"417","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":48749.38,"maximum":98734.91,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":98734.91},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":52982.85},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":54607.99},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":48749.38},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":57920.31},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":67112.73},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":59743.52},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":55999.26}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Laparoscopic Cholecystectomy Without C.D.E. With Cc","code_information":[{"code":"418","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":34556.0,"maximum":69988.26,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":69988.26},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":37556.9},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":38708.88},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":34556.0},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":41056.82},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":47572.87},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":42349.21},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":39695.09}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":55900.79,"10th_percentile":55900.79,"90th_percentile":55900.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":27515.66,"10th_percentile":27515.66,"90th_percentile":27515.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11848.28,"10th_percentile":11848.28,"90th_percentile":11848.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Laparoscopic Cholecystectomy Without C.D.E. Without Cc/Mcc","code_information":[{"code":"419","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":27900.56,"maximum":56508.61,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":56508.61},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":30323.49},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":31253.6},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":27900.56},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":33149.33},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":38410.39},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34192.8},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32049.86}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"1 through 10","median_amount":36343.95,"10th_percentile":36343.95,"90th_percentile":36343.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"1 through 10","median_amount":34192.8,"10th_percentile":34192.8,"90th_percentile":34192.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":19890.71,"10th_percentile":19890.71,"90th_percentile":19890.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"1 through 10","median_amount":32049.86,"10th_percentile":32049.86,"90th_percentile":32049.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hepatobiliary Diagnostic Procedures With Mcc","code_information":[{"code":"420","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":69600.24,"maximum":140965.36,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":140965.36},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":75644.43},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":77964.67},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":69600.24},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":82693.72},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":95817.87},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":85296.75},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":79951.01}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hepatobiliary Diagnostic Procedures With Cc","code_information":[{"code":"421","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":35493.65,"maximum":71887.33,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":71887.33},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":38575.98},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":39759.21},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":35493.65},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":42170.86},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":48863.71},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":43498.31},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":40772.18}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hepatobiliary Diagnostic Procedures Without Cc/Mcc","code_information":[{"code":"422","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":28588.99,"maximum":57902.91,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":57902.91},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":31071.7},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":32024.76},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":28588.99},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":33967.26},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":39358.14},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35036.48},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32840.67}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Hepatobiliary Or Pancreas O.R. Procedures With Mcc","code_information":[{"code":"423","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":84837.48,"maximum":171826.22,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":171826.22},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":92204.91},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":95033.1},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":84837.48},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":100797.46},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":116794.82},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":103970.36},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":97454.3}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Hepatobiliary Or Pancreas O.R. Procedures With Cc","code_information":[{"code":"424","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":44694.42,"maximum":90522.17,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":90522.17},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":48575.76},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":50065.72},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":44694.42},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":53102.52},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":61530.31},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":54774.08},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":51341.26}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Hepatobiliary Or Pancreas O.R. Procedures Without Cc/Mcc","code_information":[{"code":"425","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":30648.13,"maximum":62073.41,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":62073.41},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":33309.66},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":34331.36},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":30648.13},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":36413.78},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":42192.94},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37560.01},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35206.04}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical With Mcc Or Custom-Made","code_information":[{"code":"426","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":225141.07,"maximum":455991.13,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":455991.13},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":244692.68},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":252198.12},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":225141.07},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":267495.55},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":309949.21},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":275915.74},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":258623.48}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical With Cc","code_information":[{"code":"427","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":147461.56,"maximum":298662.36,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":298662.36},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":160267.36},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":165183.22},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":147461.56},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":175202.64},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":203008.69},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":180717.65},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":169391.67}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Without Cc/Mcc","code_information":[{"code":"428","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":114846.22,"maximum":232604.63,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":232604.63},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":124819.64},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":128648.23},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":114846.22},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":136451.56},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":158107.51},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":140746.77},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":131925.85}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Combined Anterior And Posterior Cervical Spinal Fusion With Mcc","code_information":[{"code":"429","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":184048.11,"maximum":372763.19,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":372763.19},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":200031.14},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":206166.68},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":184048.11},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":218672.0},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":253376.98},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":225555.34},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":211419.27}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Combined Anterior And Posterior Cervical Spinal Fusion Without Mcc","code_information":[{"code":"430","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":117810.32,"maximum":238608.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":238608.0},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":128041.15},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":131968.55},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":117810.32},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":139973.28},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":162188.15},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":144379.35},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":135330.77}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cirrhosis And Alcoholic Hepatitis With Mcc","code_information":[{"code":"432","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":40206.39,"maximum":81432.31,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":81432.31},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":43697.98},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":45038.32},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":40206.39},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":47770.18},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":55351.69},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":49273.89},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":46185.78}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"1 through 10","median_amount":77554.95,"10th_percentile":77554.95,"90th_percentile":77554.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14045.55,"10th_percentile":14045.55,"90th_percentile":14045.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cirrhosis And Alcoholic Hepatitis With Cc","code_information":[{"code":"433","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":21576.05,"maximum":43699.22,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":43699.22},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":23449.75},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":24169.02},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":21576.05},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":25635.03},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":29703.51},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26441.97},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24784.79}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"1 through 10","median_amount":41618.5,"10th_percentile":41618.5,"90th_percentile":41618.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":17245.32,"10th_percentile":17245.32,"90th_percentile":17245.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cirrhosis And Alcoholic Hepatitis Without Cc/Mcc","code_information":[{"code":"434","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14554.95,"maximum":29478.98,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29478.98},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":15818.93},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":16304.14},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":14554.95},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":17293.09},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":20037.64},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17837.44},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16719.53}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Malignancy Of Hepatobiliary System Or Pancreas With Mcc","code_information":[{"code":"435","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":37520.11,"maximum":75991.63,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":75991.63},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":40778.41},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":42029.21},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":37520.11},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":44578.55},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":51653.51},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":45981.78},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":43100.0}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"1 through 10","median_amount":5586.63,"10th_percentile":5586.63,"90th_percentile":5586.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Malignancy Of Hepatobiliary System Or Pancreas With Cc","code_information":[{"code":"436","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":23106.11,"maximum":46798.13,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":46798.13},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":25112.68},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":25882.96},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":23106.11},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":27452.93},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":31809.93},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28317.09},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26542.39}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"1 through 10","median_amount":28317.09,"10th_percentile":28317.09,"90th_percentile":28317.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Malignancy Of Hepatobiliary System Or Pancreas Without Cc/Mcc","code_information":[{"code":"437","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17431.21,"maximum":35304.43,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35304.43},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":18944.97},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":19526.06},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":17431.21},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":20710.44},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":23997.36},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21362.37},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20023.54}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Disorders Of Pancreas Except Malignancy With Mcc","code_information":[{"code":"438","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":33301.73,"maximum":67447.89,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":67447.89},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":36193.7},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":37303.87},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":33301.73},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":39566.58},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":45846.11},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":40812.06},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":38254.27}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7071.6,"10th_percentile":7071.6,"90th_percentile":7071.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Disorders Of Pancreas Except Malignancy With Cc","code_information":[{"code":"439","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17184.03,"maximum":34803.81,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34803.81},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":18676.32},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":19249.18},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":17184.03},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":20416.77},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":23657.07},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21059.44},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19739.6}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6608.48,"10th_percentile":6608.48,"90th_percentile":6608.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Disorders Of Pancreas Except Malignancy Without Cc/Mcc","code_information":[{"code":"440","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12693.96,"maximum":25709.8,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25709.8},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":13796.32},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":14219.5},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":12693.96},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":15082.0},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":17475.63},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15556.75},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14581.77}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Mcc","code_information":[{"code":"441","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":36662.13,"maximum":74253.92,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":74253.92},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":39845.93},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":41068.12},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":36662.13},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":43559.16},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":50472.35},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":44930.31},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":42114.43}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Cc","code_information":[{"code":"442","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":19719.15,"maximum":39938.32,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":39938.32},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":21431.59},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":22088.96},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":19719.15},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":23428.8},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":27147.13},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24166.29},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22651.73}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"1 through 10","median_amount":27147.13,"10th_percentile":27147.13,"90th_percentile":27147.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis Without Cc/Mcc","code_information":[{"code":"443","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14293.47,"maximum":28949.39,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28949.39},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":15534.74},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":16011.24},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":14293.47},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":16982.42},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":19677.66},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17516.99},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16419.16}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Disorders Of The Biliary Tract With Mcc","code_information":[{"code":"444","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":34133.15,"maximum":69131.82,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":69131.82},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":37097.32},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":38235.2},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":34133.15},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":40554.41},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":46990.72},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":41830.98},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":39209.34}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6067.15,"10th_percentile":6067.15,"90th_percentile":6067.15,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":24590.73,"10th_percentile":24590.73,"90th_percentile":24590.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Disorders Of The Biliary Tract With Cc","code_information":[{"code":"445","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":22356.4,"maximum":45279.71,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":45279.71},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":24297.87},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":25043.16},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":22356.4},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":26562.18},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":30777.81},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27398.3},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25681.19}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"1 through 10","median_amount":26078.68,"10th_percentile":26078.68,"90th_percentile":26078.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":1364.34,"10th_percentile":1364.34,"90th_percentile":1364.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9064.5,"10th_percentile":9064.5,"90th_percentile":9064.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":19371.56,"10th_percentile":19371.56,"90th_percentile":19371.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Disorders Of The Biliary Tract Without Cc/Mcc","code_information":[{"code":"446","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16900.08,"maximum":34228.71,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34228.71},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":18367.71},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":18931.11},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":16900.08},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":20079.4},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":23266.16},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20711.46},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19413.42}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Multiple Level Spinal Fusion Except Cervical With Mcc Or Custom-Made Anatomically Designed Interbody","code_information":[{"code":"447","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":136491.72,"maximum":276444.52,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":276444.52},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":148344.88},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":152895.05},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":136491.72},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":162169.11},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":187906.64},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":167273.86},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":156790.43}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Multiple Level Spinal Fusion Except Cervical Without Mcc","code_information":[{"code":"448","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":86631.06,"maximum":175458.86,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":175458.86},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":94154.24},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":97042.23},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":86631.06},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":102928.46},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":119264.02},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":106168.43},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":99514.61}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Single Level Spinal Fusion Except Cervical With Mcc Or Custom-Made Anatomically Designed Interbody F","code_information":[{"code":"450","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":108873.07,"maximum":220506.87,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":220506.87},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":118327.78},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":121957.24},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":108873.07},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":129354.72},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":149884.34},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":133426.54},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":125064.39}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Single Level Spinal Fusion Except Cervical Without Mcc","code_information":[{"code":"451","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":65990.61,"maximum":133654.57,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":133654.57},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":71721.34},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":73921.24},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":65990.61},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":78405.04},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":90848.54},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":80873.06},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":75804.57}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With","code_information":[{"code":"456","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":171664.66,"maximum":347682.27,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":347682.27},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":186572.29},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":192295.0},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":171664.66},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":203958.92},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":236328.82},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":210379.12},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":197194.18}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With","code_information":[{"code":"457","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":121814.21,"maximum":246717.3,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":246717.3},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":132392.75},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":136453.62},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":121814.21},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":144730.4},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":167700.26},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":149286.21},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":139930.1}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With","code_information":[{"code":"458","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":85237.87,"maximum":172637.15,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":172637.15},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":92640.07},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":95481.61},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":85237.87},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":101273.17},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":117346.03},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":104461.04},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":97914.23}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Bilateral Or Multiple Major Joint Procedures Of Lower Extremity With Mcc","code_information":[{"code":"461","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":112823.84,"maximum":228508.6,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":228508.6},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":122621.65},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":126382.81},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":112823.84},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":134048.73},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":155323.33},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":138268.31},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":129602.72}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Bilateral Or Multiple Major Joint Procedures Of Lower Extremity Without Mcc","code_information":[{"code":"462","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":54338.48,"maximum":110054.84,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":110054.84},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":59057.32},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":60868.78},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":54338.48},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":64560.86},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":74807.18},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":66593.1},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":62419.56}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Wit","code_information":[{"code":"463","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":116429.39,"maximum":235811.11,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":235811.11},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":126540.3},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":130421.66},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":116429.39},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":138332.56},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":160287.04},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":142686.98},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":133744.47}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Wit","code_information":[{"code":"464","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":63627.09,"maximum":128867.6,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":128867.6},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":69152.57},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":71273.68},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":63627.09},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":75596.88},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":87594.71},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":77976.51},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":73089.55}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Wit","code_information":[{"code":"465","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":37254.54,"maximum":75453.76,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":75453.76},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":40489.79},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":41731.73},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":37254.54},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":44263.02},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":51287.92},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":45656.33},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":42794.94}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Revision Of Hip Or Knee Replacement With Mcc","code_information":[{"code":"466","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":106335.91,"maximum":215368.22,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":215368.22},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":115570.29},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":119115.17},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":106335.91},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":126340.26},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":146391.46},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":130317.19},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":122149.92}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Revision Of Hip Or Knee Replacement With Cc","code_information":[{"code":"467","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":72041.38,"maximum":145909.55,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":145909.55},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":78297.57},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":80699.19},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":72041.38},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":85594.11},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":99178.57},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":88288.43},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":82755.2}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7741.36,"10th_percentile":7741.36,"90th_percentile":7741.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Revision Of Hip Or Knee Replacement Without Cc/Mcc","code_information":[{"code":"468","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":56136.14,"maximum":113695.75,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":113695.75},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":61011.1},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":62882.48},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":56136.14},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":66696.71},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":77282.0},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":68796.18},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":64484.57}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":18145.91,"10th_percentile":18145.91,"90th_percentile":18145.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity With Mcc Or Total Ankle Repl","code_information":[{"code":"469","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":61962.21,"maximum":125495.62,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":125495.62},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":67343.11},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":69408.72},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":61962.21},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":73618.8},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":85302.68},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":75936.16},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":71177.07}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity Without Mcc","code_information":[{"code":"470","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":39403.57,"maximum":79806.31,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":79806.31},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":42825.44},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":44139.02},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":39403.57},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":46816.33},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":54246.45},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":48290.01},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":45263.57}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"1 through 10","median_amount":45873.42,"10th_percentile":45873.42,"90th_percentile":45873.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13542.59,"10th_percentile":13542.59,"90th_percentile":13542.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cervical Spinal Fusion With Mcc","code_information":[{"code":"471","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":98640.68,"maximum":199782.63,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":199782.63},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":107206.8},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":110495.14},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":98640.68},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":117197.38},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":135797.53},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":120886.5},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":113310.27}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cervical Spinal Fusion With Cc","code_information":[{"code":"472","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":60182.93,"maximum":121891.94,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":121891.94},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":65409.31},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":67415.61},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":60182.93},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":71504.79},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":82853.17},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":73755.61},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":69133.18}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cervical Spinal Fusion Without Cc/Mcc","code_information":[{"code":"473","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":49870.88,"maximum":101006.35,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":101006.35},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":54201.74},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":55864.27},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":49870.88},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":59252.79},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":68656.68},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":61117.95},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":57287.55}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Amputation For Musculoskeletal System And Connective Tissue Disorders With Mcc","code_information":[{"code":"474","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":87695.36,"maximum":177614.44,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":177614.44},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":95310.97},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":98234.43},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":87695.36},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":104192.98},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":120729.23},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":107472.75},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":100737.19}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Amputation For Musculoskeletal System And Connective Tissue Disorders With Cc","code_information":[{"code":"475","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":46488.0,"maximum":94154.81,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":94154.81},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":50525.09},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":52074.84},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":46488.0},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":55233.51},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":63999.51},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":56972.15},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":53401.58}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Amputation For Musculoskeletal System And Connective Tissue Disorders Without Cc/Mcc","code_information":[{"code":"476","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":24109.13,"maximum":48829.59,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":48829.59},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":26202.8},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":27006.52},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":24109.13},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":28644.63},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":33190.76},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29546.31},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27694.57}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Biopsies Of Musculoskeletal System And Connective Tissue With Mcc","code_information":[{"code":"477","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":70570.57,"maximum":142930.62,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":142930.62},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":76699.03},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":79051.61},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":70570.57},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":83846.6},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":97153.72},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":86485.91},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":81065.64}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Biopsies Of Musculoskeletal System And Connective Tissue With Cc","code_information":[{"code":"478","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":50236.54,"maximum":101746.94,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":101746.94},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":54599.16},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":56273.87},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":50236.54},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":59687.24},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":69160.08},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":61566.07},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":57707.59}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Biopsies Of Musculoskeletal System And Connective Tissue Without Cc/Mcc","code_information":[{"code":"479","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":37973.61,"maximum":76910.13,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":76910.13},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":41271.3},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":42537.21},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":37973.61},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":45117.36},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":52277.84},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":46537.56},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":43620.95}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hip And Femur Procedures Except Major Joint With Mcc","code_information":[{"code":"480","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":59492.46,"maximum":120493.5,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":120493.5},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":64658.88},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":66642.16},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":59492.46},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":70684.43},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":81902.61},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":72909.43},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":68340.03}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hip And Femur Procedures Except Major Joint With Cc","code_information":[{"code":"481","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":42786.45,"maximum":86657.84,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":86657.84},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":46502.09},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":47928.44},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":42786.45},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":50835.61},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":58903.62},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":52435.81},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":49149.54}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"1 through 10","median_amount":49520.26,"10th_percentile":49520.26,"90th_percentile":49520.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":75538.77,"10th_percentile":75538.77,"90th_percentile":75538.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":250.0,"10th_percentile":250.0,"90th_percentile":250.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hip And Femur Procedures Except Major Joint Without Cc/Mcc","code_information":[{"code":"482","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":33318.07,"maximum":67480.99,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":67480.99},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":36211.46},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":37322.17},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":33318.07},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":39586.0},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":45868.61},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":40832.09},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":38273.05}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Joint Or Limb Reattachment Procedures Of Upper Extremities","code_information":[{"code":"483","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":56624.37,"maximum":114684.59,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":114684.59},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":61541.72},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":63429.39},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":56624.37},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":67276.78},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":77954.14},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":69394.52},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":65045.41}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Knee Procedures With Principal Diagnosis Of Infection With Mcc","code_information":[{"code":"485","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":65923.2,"maximum":133518.04,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":133518.04},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":71648.07},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":73845.73},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":65923.2},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":78324.94},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":90755.73},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":80790.45},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":75727.13}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Knee Procedures With Principal Diagnosis Of Infection With Cc","code_information":[{"code":"486","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":42716.99,"maximum":86517.17,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":86517.17},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":46426.6},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":47850.64},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":42716.99},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":50753.09},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":58808.01},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":52350.69},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":49069.75}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Knee Procedures With Principal Diagnosis Of Infection Without Cc/Mcc","code_information":[{"code":"487","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":31994.33,"maximum":64799.96,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":64799.96},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":34772.77},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":35839.35},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":31994.33},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":38013.24},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":44046.24},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":39209.82},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":36752.45}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Knee Procedures Without Principal Diagnosis Of Infection With Cc/Mcc","code_information":[{"code":"488","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":36135.09,"maximum":73186.47,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":73186.47},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":39273.12},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":40477.74},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":36135.09},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":42932.97},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":49746.77},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":44284.41},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":41509.01}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Knee Procedures Without Principal Diagnosis Of Infection Without Cc/Mcc","code_information":[{"code":"489","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":22813.99,"maximum":46206.48,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":46206.48},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":24795.19},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":25555.73},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":22813.99},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":27105.85},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":31407.77},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27959.09},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26206.83}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Mcc","code_information":[{"code":"492","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":75003.44,"maximum":151908.78,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":151908.78},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":81516.86},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":84017.22},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":75003.44},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":89113.4},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":103256.41},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":91918.51},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":86157.77}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Cc","code_information":[{"code":"493","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":51807.45,"maximum":104928.6,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":104928.6},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":56306.49},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":58033.58},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":51807.45},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":61553.68},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":71322.74},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":63491.26},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":59512.12}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"1 through 10","median_amount":63091.98,"10th_percentile":63091.98,"90th_percentile":63091.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lower Extremity And Humerus Procedures Except Hip, Foot And Femur Without Cc/Mcc","code_information":[{"code":"494","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":40988.78,"maximum":83016.93,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":83016.93},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":44548.31},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":45914.74},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":40988.78},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":48699.76},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":56428.8},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":50232.73},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":47084.53}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"1 through 10","median_amount":10755.1,"10th_percentile":10755.1,"90th_percentile":10755.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With Mcc","code_information":[{"code":"495","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":74065.8,"maximum":150009.71,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":150009.71},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":80497.79},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":82966.89},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":74065.8},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":87999.36},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":101965.56},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":90769.4},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":85080.68}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With Cc","code_information":[{"code":"496","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":36850.07,"maximum":74634.56,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":74634.56},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":40050.19},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":41278.64},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":36850.07},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":43782.46},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":50731.08},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":45160.64},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":42330.32}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur Without Cc/Mcc","code_information":[{"code":"497","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":24683.15,"maximum":49992.2,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":49992.2},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":26826.68},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":27649.53},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":24683.15},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":29326.65},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":33981.02},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30249.79},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28353.97}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur With Cc/Mcc","code_information":[{"code":"498","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":61627.19,"maximum":124817.08,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":124817.08},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":66978.99},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":69033.43},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":61627.19},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":73220.75},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":84841.47},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":75525.59},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":70792.23}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur Without Cc/Mcc","code_information":[{"code":"499","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":41158.33,"maximum":83360.34,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":83360.34},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":44732.59},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":46104.67},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":41158.33},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":48901.21},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":56662.22},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":50440.52},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":47279.3}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Soft Tissue Procedures With Mcc","code_information":[{"code":"500","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":64650.53,"maximum":130940.44,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":130940.44},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":70264.89},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":72420.12},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":64650.53},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":76812.86},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":89003.67},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":79230.77},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":74265.2}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Soft Tissue Procedures With Cc","code_information":[{"code":"501","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":35710.19,"maximum":72325.89,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":72325.89},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":38811.32},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":40001.77},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":35710.19},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":42428.14},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":49161.82},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":43763.68},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":41020.91}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Soft Tissue Procedures Without Cc/Mcc","code_information":[{"code":"502","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":27494.05,"maximum":55685.27,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":55685.27},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":29881.67},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":30798.23},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":27494.05},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":32666.34},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":37850.75},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33694.61},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31582.89}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Foot Procedures With Mcc","code_information":[{"code":"503","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":57016.59,"maximum":115478.97,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":115478.97},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":61968.0},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":63868.74},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":57016.59},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":67742.79},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":78494.11},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":69875.19},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":65495.95}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Foot Procedures With Cc","code_information":[{"code":"504","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":38184.02,"maximum":77336.28,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":77336.28},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":41499.98},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":42772.9},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":38184.02},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":45367.35},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":52567.51},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":46795.42},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":43862.65}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Foot Procedures Without Cc/Mcc","code_information":[{"code":"505","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":36623.32,"maximum":74175.31,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":74175.31},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":39803.75},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":41024.64},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":36623.32},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":43513.05},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":50418.91},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":44882.75},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":42069.84}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Thumb Or Joint Procedures","code_information":[{"code":"506","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":27561.46,"maximum":55821.8,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":55821.8},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":29954.94},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":30873.74},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":27561.46},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":32746.43},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":37943.55},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33777.22},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31660.33}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Shoulder Or Elbow Joint Procedures With Cc/Mcc","code_information":[{"code":"507","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":36901.14,"maximum":74737.99,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":74737.99},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":40105.69},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":41335.85},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":36901.14},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":43843.13},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":50801.39},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":45223.22},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":42388.98}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Shoulder Or Elbow Joint Procedures Without Cc/Mcc","code_information":[{"code":"508","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":30936.16,"maximum":62656.79,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":62656.79},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":33622.71},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":34654.02},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":30936.16},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":36756.0},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":42589.47},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37913.0},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35536.91}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Mcc","code_information":[{"code":"510","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":61702.77,"maximum":124970.17,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":124970.17},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":67061.14},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":69118.1},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":61702.77},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":73310.56},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":84945.52},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":75618.22},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":70879.05}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Cc","code_information":[{"code":"511","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":42477.98,"maximum":86033.1,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":86033.1},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":46166.84},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":47582.91},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":42477.98},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":50469.12},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":58478.97},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":52057.78},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":48795.2}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures Without Cc/Mcc","code_information":[{"code":"512","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":33816.51,"maximum":68490.52,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":68490.52},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":36753.19},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":37880.52},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":33816.51},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":40178.21},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":46554.81},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":41442.94},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":38845.62}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures With Cc/Mcc","code_information":[{"code":"513","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":32159.8,"maximum":65135.09,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":65135.09},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":34952.61},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":36024.71},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":32159.8},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":38209.84},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":44274.04},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":39412.6},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":36942.52}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures Without Cc/Mcc","code_information":[{"code":"514","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":20883.54,"maximum":42296.64,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":42296.64},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":22697.1},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":23393.29},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":20883.54},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":24812.24},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":28750.14},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25593.28},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23989.29}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Musculoskeletal System And Connective Tissue O.R. Procedures With Mcc","code_information":[{"code":"515","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":65101.99,"maximum":131854.8,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":131854.8},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":70755.55},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":72925.83},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":65101.99},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":77349.25},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":89625.19},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":79784.04},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":74783.8}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Musculoskeletal System And Connective Tissue O.R. Procedures With Cc","code_information":[{"code":"516","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":42451.43,"maximum":85979.31,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":85979.31},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":46137.98},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":47553.16},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":42451.43},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":50437.57},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":58442.41},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":52025.23},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":48764.69}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Musculoskeletal System And Connective Tissue O.R. Procedures Without Cc/Mcc","code_information":[{"code":"517","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":31391.71,"maximum":63579.43,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":63579.43},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":34117.81},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":35164.31},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":31391.71},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":37297.25},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":43216.61},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":38471.28},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":36060.2}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Back And Neck Procedures Except Spinal Fusion With Mcc Or Disc Device Or Neurostimulator","code_information":[{"code":"518","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":76345.56,"maximum":154627.05,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":154627.05},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":82975.53},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":85520.64},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":76345.56},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":90708.01},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":105104.09},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":93563.31},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":87699.48}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Back And Neck Procedures Except Spinal Fusion With Cc","code_information":[{"code":"519","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":40860.09,"maximum":82756.27,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":82756.27},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":44408.44},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":45770.58},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":40860.09},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":48546.85},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":56251.62},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":50075.01},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":46936.69}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Back And Neck Procedures Except Spinal Fusion Without Cc/Mcc","code_information":[{"code":"520","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":30517.39,"maximum":61808.62,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":61808.62},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":33167.57},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":34184.91},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":30517.39},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":36258.45},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":42012.95},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37399.79},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35055.86}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"1 through 10","median_amount":37399.79,"10th_percentile":37399.79,"90th_percentile":37399.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14854.09,"10th_percentile":14854.09,"90th_percentile":14854.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Hip Replacement With Principal Diagnosis Of Hip Fracture With Mcc","code_information":[{"code":"521","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":58632.45,"maximum":118751.65,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":118751.65},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":63724.18},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":65678.79},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":58632.45},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":69662.62},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":80718.63},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":71855.46},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":67352.11}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hip Replacement With Principal Diagnosis Of Hip Fracture Without Mcc","code_information":[{"code":"522","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":43260.38,"maximum":87617.72,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":87617.72},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":47017.18},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":48459.33},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":43260.38},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":51398.7},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":59556.08},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":53016.62},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":49693.95}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Fractures Of Femur With Mcc","code_information":[{"code":"533","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":32024.98,"maximum":64862.02,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":64862.02},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":34806.08},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":35873.68},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":32024.98},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":38049.65},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":44088.43},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":39247.37},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":36787.65}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Fractures Of Femur Without Mcc","code_information":[{"code":"534","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16467.01,"maximum":33351.58,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33351.58},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":17897.03},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":18445.99},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":16467.01},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":19564.85},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":22669.95},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20180.71},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18915.94}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Fractures Of Hip And Pelvis With Mcc","code_information":[{"code":"535","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":26188.7,"maximum":53041.47,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":53041.47},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":28462.96},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":29336.01},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":26188.7},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":31115.42},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":36053.69},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32094.87},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30083.41}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Fractures Of Hip And Pelvis Without Mcc","code_information":[{"code":"536","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16497.65,"maximum":33413.64,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33413.64},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":17930.34},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":18480.31},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":16497.65},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":19601.26},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":22712.13},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20218.27},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18951.14}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh With Cc/Mcc","code_information":[{"code":"537","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":19494.44,"maximum":39483.21,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":39483.21},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":21187.37},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":21837.25},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":19494.44},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":23161.82},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":26837.78},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23890.9},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22393.6}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh Without Cc/Mcc","code_information":[{"code":"538","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14714.29,"maximum":29801.69,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29801.69},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":15992.1},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":16482.62},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":14714.29},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":17482.4},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":20257.0},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18032.71},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16902.56}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Osteomyelitis With Mcc","code_information":[{"code":"539","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":40237.03,"maximum":81494.37,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":81494.37},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":43731.28},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":45072.65},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":40237.03},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":47806.59},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":55393.87},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":49311.44},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":46220.98}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Osteomyelitis With Cc","code_information":[{"code":"540","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":26480.82,"maximum":53633.12,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":53633.12},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":28780.45},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":29663.23},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":26480.82},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":31462.5},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":36455.84},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32452.87},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30418.98}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Osteomyelitis Without Cc/Mcc","code_information":[{"code":"541","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16085.01,"maximum":32577.89,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32577.89},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":17481.85},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":18018.07},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":16085.01},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":19110.99},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":22144.05},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19712.56},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18477.13}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With Mcc","code_information":[{"code":"542","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":36086.06,"maximum":73087.17,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":73087.17},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":39219.83},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":40422.82},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":36086.06},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":42874.72},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":49679.28},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":44224.33},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":41452.69}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With Cc","code_information":[{"code":"543","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":20999.98,"maximum":42532.47,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":42532.47},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":22823.66},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":23523.72},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":20999.98},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":24950.59},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":28910.44},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25735.98},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24123.05}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy Without Cc/Mcc","code_information":[{"code":"544","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15414.97,"maximum":31220.82,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31220.82},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":16753.63},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":17267.51},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":15414.97},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":18314.9},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":21221.62},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18891.41},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17707.44}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Connective Tissue Disorders With Mcc","code_information":[{"code":"545","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":50696.17,"maximum":102677.86,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":102677.86},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":55098.7},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":56788.74},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":50696.17},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":60233.34},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":69792.85},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":62129.36},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":58235.57}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Connective Tissue Disorders With Cc","code_information":[{"code":"546","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":23561.66,"maximum":47720.77,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":47720.77},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":25607.79},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":26393.25},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":23561.66},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":27994.17},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":32437.07},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28875.37},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27065.68}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Connective Tissue Disorders Without Cc/Mcc","code_information":[{"code":"547","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17081.89,"maximum":34596.94,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34596.94},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":18565.31},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":19134.76},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":17081.89},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":20295.41},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":23516.45},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20934.27},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19622.27}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Septic Arthritis With Mcc","code_information":[{"code":"548","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":39444.43,"maximum":79889.06,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":79889.06},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":42869.84},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":44184.78},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":39444.43},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":46864.87},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":54302.7},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":48340.08},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":45310.5}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Septic Arthritis With Cc","code_information":[{"code":"549","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":24660.68,"maximum":49946.69,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":49946.69},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":26802.25},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":27624.36},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":24660.68},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":29299.95},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":33950.09},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30222.25},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28328.16}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Septic Arthritis Without Cc/Mcc","code_information":[{"code":"550","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17856.11,"maximum":36165.01,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":36165.01},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":19406.77},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":20002.03},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":17856.11},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":21215.28},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":24582.31},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21883.09},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20511.63}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Medical Back Problems With Mcc","code_information":[{"code":"551","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":34239.37,"maximum":69346.96,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":69346.96},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":37212.77},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":38354.2},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":34239.37},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":40680.62},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":47136.96},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":41961.16},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":39331.36}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Medical Back Problems Without Mcc","code_information":[{"code":"552","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":19637.44,"maximum":39772.83,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":39772.83},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":21342.78},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":21997.43},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":19637.44},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":23331.71},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":27034.64},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24066.15},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22557.87}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"1 through 10","median_amount":32099.33,"10th_percentile":32099.33,"90th_percentile":32099.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"1 through 10","median_amount":22831.71,"10th_percentile":22831.71,"90th_percentile":22831.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7229.03,"10th_percentile":7229.03,"90th_percentile":7229.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Bone Diseases And Arthropathies With Mcc","code_information":[{"code":"553","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":26480.82,"maximum":53633.12,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":53633.12},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":28780.45},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":29663.23},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":26480.82},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":31462.5},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":36455.84},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32452.87},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30418.98}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Bone Diseases And Arthropathies Without Mcc","code_information":[{"code":"554","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16957.28,"maximum":34344.56,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34344.56},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":18429.88},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":18995.18},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":16957.28},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":20147.36},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":23344.9},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20781.55},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19479.13}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"1 through 10","median_amount":16536.23,"10th_percentile":16536.23,"90th_percentile":16536.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5519.9,"10th_percentile":5519.9,"90th_percentile":5519.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5856.02,"10th_percentile":5856.02,"90th_percentile":5856.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Signs And Symptoms Of Musculoskeletal System And Connective Tissue With Mcc","code_information":[{"code":"555","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":27001.73,"maximum":54688.15,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":54688.15},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":29346.6},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":30246.75},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":27001.73},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":32081.41},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":37172.98},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33091.26},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31017.36}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":2048.94,"10th_percentile":2048.94,"90th_percentile":2048.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10703.46,"10th_percentile":10703.46,"90th_percentile":10703.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Signs And Symptoms Of Musculoskeletal System And Connective Tissue Without Mcc","code_information":[{"code":"556","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16967.5,"maximum":34365.24,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34365.24},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":18440.98},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":19006.62},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":16967.5},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":20159.49},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":23358.96},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20794.07},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19490.86}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Tendonitis, Myositis And Bursitis With Mcc","code_information":[{"code":"557","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":30374.39,"maximum":61519.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":61519.0},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":33012.15},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":34024.73},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":30374.39},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":36088.55},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":41816.09},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37224.54},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34891.6}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Tendonitis, Myositis And Bursitis Without Mcc","code_information":[{"code":"558","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":18246.29,"maximum":36955.26,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":36955.26},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":19830.83},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":20439.1},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":18246.29},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":21678.86},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":25119.46},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22361.26},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20959.83}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Aftercare, Musculoskeletal System And Connective Tissue With Mcc","code_information":[{"code":"559","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":38096.18,"maximum":77158.37,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":77158.37},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":41404.51},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":42674.51},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":38096.18},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":45262.99},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":52446.58},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":46687.77},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":43761.74}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Aftercare, Musculoskeletal System And Connective Tissue With Cc","code_information":[{"code":"560","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":23003.97,"maximum":46591.26,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":46591.26},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":25001.67},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":25768.55},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":23003.97},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":27331.57},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":31669.31},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28191.91},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26425.06}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":300.0,"10th_percentile":300.0,"90th_percentile":300.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Aftercare, Musculoskeletal System And Connective Tissue Without Cc/Mcc","code_information":[{"code":"561","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16422.07,"maximum":33260.56,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33260.56},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":17848.19},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":18395.64},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":16422.07},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":19511.46},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":22608.08},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20125.64},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18864.32}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh With Mcc","code_information":[{"code":"562","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":29105.81,"maximum":58949.68,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":58949.68},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":31633.41},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":32603.7},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":29105.81},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":34581.32},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":40069.65},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35669.87},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33434.36}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh Without Mcc","code_information":[{"code":"563","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":18293.27,"maximum":37050.42,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37050.42},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":19881.89},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":20491.73},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":18293.27},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":21734.68},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":25184.15},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22418.84},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21013.8}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":4273.65,"10th_percentile":4273.65,"90th_percentile":4273.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Musculoskeletal System And Connective Tissue Diagnoses With Mcc","code_information":[{"code":"564","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":31532.66,"maximum":63864.91,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":63864.91},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":34271.01},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":35322.2},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":31532.66},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":37464.72},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":43410.66},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":38644.03},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":36222.12}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Musculoskeletal System And Connective Tissue Diagnoses With Cc","code_information":[{"code":"565","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":19905.04,"maximum":40314.83,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":40314.83},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":21633.63},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":22297.2},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":19905.04},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":23649.66},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":27403.05},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24394.1},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22865.27}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7582.2,"10th_percentile":7582.2,"90th_percentile":7582.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Musculoskeletal System And Connective Tissue Diagnoses Without Cc/Mcc","code_information":[{"code":"566","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15306.7,"maximum":31001.54,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31001.54},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":16635.96},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":17146.23},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":15306.7},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":18186.26},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":21072.56},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18758.73},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17583.07}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Debridement With Mcc","code_information":[{"code":"570","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":60080.79,"maximum":121685.07,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":121685.07},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":65298.3},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":67301.19},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":60080.79},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":71383.44},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":82712.56},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":73630.44},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":69015.85}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Debridement With Cc","code_information":[{"code":"571","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":34513.11,"maximum":69901.37,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":69901.37},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":37510.28},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":38660.83},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":34513.11},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":41005.85},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":47513.81},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":42296.63},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":39645.81}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Debridement Without Cc/Mcc","code_information":[{"code":"572","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":23416.62,"maximum":47427.02,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":47427.02},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":25450.15},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":26230.78},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":23416.62},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":27821.85},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":32237.39},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28697.62},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26899.08}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Graft For Skin Ulcer Or Cellulitis With Mcc","code_information":[{"code":"573","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":133832.0,"maximum":271057.62,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":271057.62},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":145454.18},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":149915.69},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":133832.0},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":159009.03},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":184245.02},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":164014.3},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":153735.15}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Graft For Skin Ulcer Or Cellulitis With Cc","code_information":[{"code":"574","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":70913.76,"maximum":143625.7,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":143625.7},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":77072.02},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":79436.05},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":70913.76},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":84254.35},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":97626.18},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":86906.5},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":81459.87}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"1 through 10","median_amount":69039.25,"10th_percentile":69039.25,"90th_percentile":69039.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Graft For Skin Ulcer Or Cellulitis Without Cc/Mcc","code_information":[{"code":"575","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":36709.12,"maximum":74349.08,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":74349.08},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":39896.99},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":41120.75},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":36709.12},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":43614.99},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":50537.03},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":44987.9},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":42168.4}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Graft Except For Skin Ulcer Or Cellulitis With Mcc","code_information":[{"code":"576","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":100121.71,"maximum":202782.25,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":202782.25},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":108816.44},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":112154.16},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":100121.71},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":118957.03},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":137836.45},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":122701.54},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":115011.56}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Graft Except For Skin Ulcer Or Cellulitis With Cc","code_information":[{"code":"577","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":54148.5,"maximum":109670.06,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":109670.06},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":58850.84},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":60655.97},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":54148.5},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":64335.14},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":74545.64},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":66360.27},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":62201.33}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Graft Except For Skin Ulcer Or Cellulitis Without Cc/Mcc","code_information":[{"code":"578","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":32815.54,"maximum":66463.19,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":66463.19},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":35665.29},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":36759.25},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":32815.54},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":38988.93},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":45176.79},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":40216.22},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37695.78}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Skin, Subcutaneous Tissue And Breast Procedures With Mcc","code_information":[{"code":"579","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":66156.08,"maximum":133989.7,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":133989.7},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":71901.18},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":74106.6},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":66156.08},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":78601.63},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":91076.34},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":81075.85},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":75994.64}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Skin, Subcutaneous Tissue And Breast Procedures With Cc","code_information":[{"code":"580","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":35299.58,"maximum":71494.27,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":71494.27},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":38365.06},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":39541.82},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":35299.58},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":41940.29},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":48596.54},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":43260.48},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":40549.25}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":29614.27,"10th_percentile":29614.27,"90th_percentile":29614.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"1 through 10","median_amount":4397.31,"10th_percentile":4397.31,"90th_percentile":4397.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Skin, Subcutaneous Tissue And Breast Procedures Without Cc/Mcc","code_information":[{"code":"581","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":29479.65,"maximum":59706.82,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":59706.82},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":32039.71},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":33022.46},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":29479.65},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":35025.48},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":40584.3},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":36128.01},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33863.78}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"1 through 10","median_amount":36128.01,"10th_percentile":36128.01,"90th_percentile":36128.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Mastectomy For Malignancy With Cc/Mcc","code_information":[{"code":"582","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":39356.58,"maximum":79711.15,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":79711.15},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":42774.37},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":44086.39},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":39356.58},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":46760.51},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":54181.77},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":48232.43},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":45209.6}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Mastectomy For Malignancy Without Cc/Mcc","code_information":[{"code":"583","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":35226.04,"maximum":71345.33,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":71345.33},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":38285.13},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":39459.45},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":35226.04},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":41852.91},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":48495.3},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":43170.35},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":40464.77}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Breast Biopsy, Local Excision And Other Breast Procedures With Cc/Mcc","code_information":[{"code":"584","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":43730.22,"maximum":88569.32,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":88569.32},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":47527.82},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":48985.64},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":43730.22},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":51956.93},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":60202.91},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":53592.42},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":50233.67}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Breast Biopsy, Local Excision And Other Breast Procedures Without Cc/Mcc","code_information":[{"code":"585","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":39407.65,"maximum":79814.58,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":79814.58},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":42829.88},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":44143.6},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":39407.65},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":46821.19},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":54252.08},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":48295.02},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":45268.26}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Ulcers With Mcc","code_information":[{"code":"592","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":39534.31,"maximum":80071.1,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":80071.1},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":42967.53},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":44285.47},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":39534.31},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":46971.67},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":54426.44},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":48450.24},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":45413.75}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Ulcers With Cc","code_information":[{"code":"593","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":24233.74,"maximum":49081.98,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":49081.98},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":26338.23},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":27146.1},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":24233.74},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":28792.69},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":33362.31},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29699.02},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27837.72}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Ulcers Without Cc/Mcc","code_information":[{"code":"594","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17706.99,"maximum":35862.98,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35862.98},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":19244.69},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":19834.98},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":17706.99},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":21038.1},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":24377.02},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21700.34},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20340.33}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Skin Disorders With Mcc","code_information":[{"code":"595","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":43321.66,"maximum":87741.84,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":87741.84},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":47083.78},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":48527.98},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":43321.66},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":51471.51},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":59640.45},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":53091.72},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":49764.35}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Skin Disorders Without Mcc","code_information":[{"code":"596","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":22113.31,"maximum":44787.36,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":44787.36},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":24033.67},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":24770.85},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":22113.31},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":26273.36},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":30443.15},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27100.39},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25401.95}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Malignant Breast Disorders With Mcc","code_information":[{"code":"597","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":34055.52,"maximum":68974.6,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":68974.6},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":37012.95},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":38148.25},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":34055.52},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":40462.18},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":46883.85},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":41735.85},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":39120.17}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Malignant Breast Disorders With Cc","code_information":[{"code":"598","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":23110.2,"maximum":46806.41,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":46806.41},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":25117.12},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":25887.54},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":23110.2},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":27457.78},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":31815.55},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28322.1},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26547.09}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Malignant Breast Disorders Without Cc/Mcc","code_information":[{"code":"599","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15717.3,"maximum":31833.16,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31833.16},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":17082.22},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":17606.18},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":15717.3},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":18674.11},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":21637.84},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19261.93},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18054.74}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Non-Malignant Breast Disorders With Cc/Mcc","code_information":[{"code":"600","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":21277.8,"maximum":43095.16,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":43095.16},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":23125.6},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":23834.93},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":21277.8},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":25280.67},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":29292.92},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26076.46},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24442.19}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Non-Malignant Breast Disorders Without Cc/Mcc","code_information":[{"code":"601","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12358.94,"maximum":25031.27,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25031.27},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":13432.21},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":13844.22},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":12358.94},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":14683.96},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":17014.42},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15146.18},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14196.93}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cellulitis With Mcc","code_information":[{"code":"602","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":29034.32,"maximum":58804.87,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":58804.87},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":31555.7},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":32523.61},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":29034.32},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":34496.37},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":39971.22},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35582.25},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33352.23}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":22417.93,"10th_percentile":22417.93,"90th_percentile":22417.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":7260.99,"10th_percentile":7260.99,"90th_percentile":7260.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cellulitis Without Mcc","code_information":[{"code":"603","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17790.75,"maximum":36032.62,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":36032.62},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":19335.72},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":19928.8},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":17790.75},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":21137.61},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":24492.32},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21802.98},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20436.54}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"1 through 10","median_amount":4405.06,"10th_percentile":4405.06,"90th_percentile":4405.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"1 through 10","median_amount":15990.75,"10th_percentile":15990.75,"90th_percentile":15990.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6603.26,"10th_percentile":6603.26,"90th_percentile":6603.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15939.53,"10th_percentile":15939.53,"90th_percentile":15939.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"1 through 10","median_amount":2546.92,"10th_percentile":2546.92,"90th_percentile":2546.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Trauma To The Skin, Subcutaneous Tissue And Breast With Mcc","code_information":[{"code":"604","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":30072.06,"maximum":60906.67,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":60906.67},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":32683.56},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":33686.06},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":30072.06},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":35729.34},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":41399.87},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":36854.02},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34544.3}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Trauma To The Skin, Subcutaneous Tissue And Breast Without Mcc","code_information":[{"code":"605","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":18712.05,"maximum":37898.58,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37898.58},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":20337.03},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":20960.83},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":18712.05},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":22232.24},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":25760.67},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22932.06},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21494.86}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Minor Skin Disorders With Mcc","code_information":[{"code":"606","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":30911.65,"maximum":62607.14,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":62607.14},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":33596.07},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":34626.56},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":30911.65},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":36726.88},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":42555.72},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37882.96},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35508.75}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Minor Skin Disorders Without Mcc","code_information":[{"code":"607","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":18515.94,"maximum":37501.39,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37501.39},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":20123.89},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":20741.15},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":18515.94},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":21999.23},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":25490.69},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22691.72},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21269.58}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Adrenal And Pituitary Procedures With Cc/Mcc","code_information":[{"code":"614","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":44774.09,"maximum":90683.53,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":90683.53},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":48662.34},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":50154.96},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":44774.09},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":53197.18},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":61639.99},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":54871.71},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":51432.78}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Adrenal And Pituitary Procedures Without Cc/Mcc","code_information":[{"code":"615","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":28584.9,"maximum":57894.64,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":57894.64},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":31067.26},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":32020.18},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":28584.9},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":33962.41},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":39352.51},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35031.48},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32835.97}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With Mcc","code_information":[{"code":"616","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":71240.61,"maximum":144287.69,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":144287.69},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":77427.25},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":79802.17},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":71240.61},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":84642.69},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":98076.15},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":87307.06},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":81835.33}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With Cc","code_information":[{"code":"617","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":38206.49,"maximum":77381.79,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":77381.79},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":41524.4},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":42798.07},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":38206.49},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":45394.05},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":52598.45},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":46822.96},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":43888.46}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13620.51,"10th_percentile":13620.51,"90th_percentile":13620.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders Without Cc/Mcc","code_information":[{"code":"618","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":28973.03,"maximum":58680.74,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":58680.74},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":31489.1},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":32454.96},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":28973.03},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":34423.56},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":39886.85},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35507.14},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33281.83}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"O.R. Procedures For Obesity With Mcc","code_information":[{"code":"619","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":58983.81,"maximum":119463.29,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":119463.29},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":64106.05},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":66072.37},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":58983.81},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":70080.09},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":81202.35},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":72286.06},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":67755.73}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"O.R. Procedures For Obesity With Cc","code_information":[{"code":"620","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":32690.93,"maximum":66210.81,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":66210.81},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":35529.86},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":36619.66},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":32690.93},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":38840.88},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":45005.24},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":40063.51},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37552.64}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"O.R. Procedures For Obesity Without Cc/Mcc","code_information":[{"code":"621","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":30813.6,"maximum":62408.54,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":62408.54},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":33489.5},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":34516.72},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":30813.6},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":36610.38},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":42420.73},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37762.79},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35396.11}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"1 through 10","median_amount":4391.65,"10th_percentile":4391.65,"90th_percentile":5429.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With Mcc","code_information":[{"code":"622","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":72707.34,"maximum":147258.34,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":147258.34},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":79021.36},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":81445.17},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":72707.34},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":86385.34},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":100095.38},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":89104.57},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":83520.19}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With Cc","code_information":[{"code":"623","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":36645.79,"maximum":74220.82,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":74220.82},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":39828.17},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":41049.81},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":36645.79},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":43539.75},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":50449.85},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":44910.29},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":42095.66}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders Without Cc/Mcc","code_information":[{"code":"624","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":25573.81,"maximum":51796.11,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":51796.11},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":27794.68},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":28647.23},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":25573.81},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":30384.86},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":35207.18},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31341.32},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29377.09}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Thyroid, Parathyroid And Thyroglossal Procedures With Mcc","code_information":[{"code":"625","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":61694.6,"maximum":124953.62,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":124953.62},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":67052.26},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":69108.95},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":61694.6},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":73300.85},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":84934.27},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":75608.2},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":70869.67}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Thyroid, Parathyroid And Thyroglossal Procedures With Cc","code_information":[{"code":"626","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":30629.74,"maximum":62036.18,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":62036.18},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":33289.68},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":34310.77},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":30629.74},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":36391.94},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":42167.63},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37537.48},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35184.92}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Thyroid, Parathyroid And Thyroglossal Procedures Without Cc/Mcc","code_information":[{"code":"627","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":27134.51,"maximum":54957.08,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":54957.08},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":29490.92},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":30395.49},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":27134.51},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":32239.17},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":37355.78},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33253.99},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31169.89}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Endocrine, Nutritional And Metabolic O.R. Procedures With Mcc","code_information":[{"code":"628","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":76131.07,"maximum":154192.62,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":154192.62},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":82742.41},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":85280.36},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":76131.07},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":90453.16},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":104808.8},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":93300.44},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":87453.09}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Endocrine, Nutritional And Metabolic O.R. Procedures With Cc","code_information":[{"code":"629","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":44508.53,"maximum":90145.67,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":90145.67},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":48373.72},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":49857.48},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":44508.53},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":52881.65},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":61274.39},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":54546.26},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":51127.72}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Endocrine, Nutritional And Metabolic O.R. Procedures Without Cc/Mcc","code_information":[{"code":"630","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":29814.67,"maximum":60385.35,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":60385.35},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":32403.82},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":33397.74},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":29814.67},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":35423.52},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":41045.52},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":36538.58},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34248.63}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Diabetes With Mcc","code_information":[{"code":"637","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":29348.91,"maximum":59442.03,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":59442.03},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":31897.61},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":32876.01},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":29348.91},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":34870.15},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":40404.31},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35967.78},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33713.6}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"1 through 10","median_amount":4022.62,"10th_percentile":4022.62,"90th_percentile":4022.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Diabetes With Cc","code_information":[{"code":"638","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":18307.57,"maximum":37079.38,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37079.38},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":19897.43},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":20507.74},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":18307.57},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":21751.67},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":25203.83},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22436.37},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21030.23}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":17303.34,"10th_percentile":17303.34,"90th_percentile":17303.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"1 through 10","median_amount":21751.67,"10th_percentile":21751.67,"90th_percentile":21751.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"1 through 10","median_amount":18754.26,"10th_percentile":18754.26,"90th_percentile":18754.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7009.31,"10th_percentile":7009.31,"90th_percentile":7009.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5497.78,"10th_percentile":5497.78,"90th_percentile":5497.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Diabetes Without Cc/Mcc","code_information":[{"code":"639","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12689.87,"maximum":25701.53,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25701.53},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":13791.88},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":14214.92},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":12689.87},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":15077.15},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":17470.01},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15551.74},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14577.08}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes With Mcc","code_information":[{"code":"640","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":27283.64,"maximum":55259.11,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":55259.11},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":29652.99},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":30562.53},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":27283.64},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":32416.35},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":37561.08},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33436.75},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31341.19}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15385.52,"10th_percentile":15385.52,"90th_percentile":15385.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"1 through 10","median_amount":15731.57,"10th_percentile":15731.57,"90th_percentile":15731.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9469.61,"10th_percentile":9469.61,"90th_percentile":9469.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"1 through 10","median_amount":3392.5,"10th_percentile":3392.5,"90th_percentile":3392.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes Without Mcc","code_information":[{"code":"641","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15897.07,"maximum":32197.25,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32197.25},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":17277.6},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":17807.55},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":15897.07},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":18887.69},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":21885.32},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19482.24},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18261.24}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6634.54,"10th_percentile":6634.54,"90th_percentile":6634.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5832.86,"10th_percentile":5832.86,"90th_percentile":5832.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12463.17,"10th_percentile":12463.17,"90th_percentile":12463.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":3992.27,"10th_percentile":3992.27,"90th_percentile":3992.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Inborn And Other Disorders Of Metabolism","code_information":[{"code":"642","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":29050.66,"maximum":58837.97,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":58837.97},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":31573.46},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":32541.91},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":29050.66},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":34515.79},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":39993.72},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35602.27},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33371.0}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Endocrine Disorders With Mcc","code_information":[{"code":"643","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":33626.53,"maximum":68105.74,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":68105.74},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":36546.71},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":37667.71},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":33626.53},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":39952.49},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":46293.27},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":41210.11},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":38627.38}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14330.24,"10th_percentile":14330.24,"90th_percentile":14330.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Endocrine Disorders With Cc","code_information":[{"code":"644","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":20938.7,"maximum":42408.35,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":42408.35},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":22757.05},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":23455.08},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":20938.7},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":24877.78},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":28826.08},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25660.88},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24052.65}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Endocrine Disorders Without Cc/Mcc","code_information":[{"code":"645","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15694.83,"maximum":31787.64,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31787.64},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":17057.8},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":17581.01},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":15694.83},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":18647.41},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":21606.9},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19234.39},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18028.93}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"1 through 10","median_amount":30274.09,"10th_percentile":30274.09,"90th_percentile":30274.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney Transplant With Hemodialysis With Mcc","code_information":[{"code":"650","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":96040.2,"maximum":194515.72,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":194515.72},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":104380.48},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":107582.14},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":96040.2},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":114107.68},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":132217.47},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":117699.55},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":110323.05}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney Transplant With Hemodialysis Without Mcc","code_information":[{"code":"651","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":75702.08,"maximum":153323.77,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":153323.77},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":82276.17},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":84799.82},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":75702.08},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":89943.47},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":104218.21},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":92774.7},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":86960.3}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney Transplant","code_information":[{"code":"652","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":65972.23,"maximum":133617.33,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":133617.33},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":71701.36},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":73900.65},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":65972.23},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":78383.19},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":90823.23},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":80850.53},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":75783.45}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Bladder Procedures With Mcc","code_information":[{"code":"653","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":106152.06,"maximum":214995.85,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":214995.85},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":115370.47},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":118909.22},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":106152.06},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":126121.82},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":146138.36},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":130091.87},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":121938.72}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Bladder Procedures With Cc","code_information":[{"code":"654","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":57184.1,"maximum":115818.24,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":115818.24},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":62150.06},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":64056.38},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":57184.1},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":67941.81},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":78724.71},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":70080.48},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":65688.37}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Bladder Procedures Without Cc/Mcc","code_information":[{"code":"655","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":43237.9,"maximum":87572.21,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":87572.21},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":46992.75},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":48434.16},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":43237.9},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":51372.0},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":59525.14},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":52989.08},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":49668.14}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney And Ureter Procedures For Neoplasm With Mcc","code_information":[{"code":"656","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":65038.67,"maximum":131726.54,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":131726.54},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":70686.73},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":72854.9},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":65038.67},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":77274.01},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":89538.01},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":79706.43},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":74711.05}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":22810.41,"10th_percentile":22810.41,"90th_percentile":22810.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney And Ureter Procedures For Neoplasm With Cc","code_information":[{"code":"657","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":37383.24,"maximum":75714.42,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":75714.42},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":40629.66},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":41875.89},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":37383.24},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":44415.93},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":51465.09},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":45814.05},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":42942.78}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"1 through 10","median_amount":36763.46,"10th_percentile":36763.46,"90th_percentile":36763.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney And Ureter Procedures For Neoplasm Without Cc/Mcc","code_information":[{"code":"658","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":31700.17,"maximum":64204.17,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":64204.17},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":34453.06},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":35509.84},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":31700.17},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":37663.74},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":43641.27},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":38849.31},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":36414.54}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney And Ureter Procedures For Non-Neoplasm With Mcc","code_information":[{"code":"659","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":51905.51,"maximum":105127.2,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":105127.2},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":56413.06},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":58143.41},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":51905.51},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":61670.18},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":71457.73},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":63611.43},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":59624.76}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney And Ureter Procedures For Non-Neoplasm With Cc","code_information":[{"code":"660","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":26999.69,"maximum":54684.02,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":54684.02},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":29344.38},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":30244.46},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":26999.69},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":32078.98},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":37170.17},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33088.76},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31015.01}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"1 through 10","median_amount":32005.5,"10th_percentile":32005.5,"90th_percentile":32005.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":21835.52,"10th_percentile":21835.52,"90th_percentile":21835.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"1 through 10","median_amount":31015.01,"10th_percentile":31015.01,"90th_percentile":31015.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney And Ureter Procedures For Non-Neoplasm Without Cc/Mcc","code_information":[{"code":"661","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":21151.15,"maximum":42838.64,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":42838.64},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":22987.95},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":23693.06},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":21151.15},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":25130.19},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":29118.55},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25921.24},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24296.7}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"1 through 10","median_amount":40798.9,"10th_percentile":40798.9,"90th_percentile":40798.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6781.15,"10th_percentile":6781.15,"90th_percentile":6781.15,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7253.25,"10th_percentile":7253.25,"90th_percentile":7253.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6314.38,"10th_percentile":6314.38,"90th_percentile":6314.38,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Minor Bladder Procedures With Mcc","code_information":[{"code":"662","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":62540.32,"maximum":126666.5,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":126666.5},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":67971.42},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":70056.3},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":62540.32},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":74305.67},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":86098.56},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":76644.65},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":71841.16}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Minor Bladder Procedures With Cc","code_information":[{"code":"663","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":31054.65,"maximum":62896.75,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":62896.75},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":33751.48},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":34786.74},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":31054.65},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":36896.77},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":42752.58},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":38058.21},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35673.01}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Minor Bladder Procedures Without Cc/Mcc","code_information":[{"code":"664","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":21386.07,"maximum":43314.44,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":43314.44},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":23243.27},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":23956.21},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":21386.07},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":25409.31},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":29441.97},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26209.14},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24566.56}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Prostatectomy With Mcc","code_information":[{"code":"665","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":63759.87,"maximum":129136.53,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":129136.53},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":69296.88},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":71422.42},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":63759.87},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":75754.65},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":87777.51},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":78139.24},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":73242.08}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Prostatectomy With Cc","code_information":[{"code":"666","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":35734.7,"maximum":72375.54,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":72375.54},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":38837.96},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":40029.23},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":35734.7},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":42457.26},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":49195.56},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":43793.73},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":41049.07}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"1 through 10","median_amount":43793.73,"10th_percentile":43793.73,"90th_percentile":43793.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Prostatectomy Without Cc/Mcc","code_information":[{"code":"667","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":22597.45,"maximum":45767.92,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":45767.92},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":24559.85},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":25313.17},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":22597.45},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":26848.58},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":31109.66},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27693.72},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25958.09}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Transurethral Procedures With Mcc","code_information":[{"code":"668","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":59649.76,"maximum":120812.08,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":120812.08},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":64829.84},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":66818.36},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":59649.76},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":70871.32},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":82119.16},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":73102.2},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":68520.72}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Transurethral Procedures With Cc","code_information":[{"code":"669","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":31704.26,"maximum":64212.45,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":64212.45},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":34457.5},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":35514.42},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":31704.26},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":37668.59},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":43646.9},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":38854.32},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":36419.23}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Transurethral Procedures Without Cc/Mcc","code_information":[{"code":"670","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":19964.28,"maximum":40434.81,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":40434.81},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":21698.01},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":22363.56},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":19964.28},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":23720.05},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":27484.61},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24466.71},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22933.32}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Urethral Procedures With Cc/Mcc","code_information":[{"code":"671","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":36668.26,"maximum":74266.33,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":74266.33},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":39852.59},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":41074.99},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":36668.26},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":43566.45},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":50480.79},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":44937.83},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":42121.47}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Urethral Procedures Without Cc/Mcc","code_information":[{"code":"672","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":22052.03,"maximum":44663.23,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":44663.23},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":23967.06},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":24702.2},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":22052.03},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":26200.54},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":30358.78},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27025.28},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25331.55}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Kidney And Urinary Tract Procedures With Mcc","code_information":[{"code":"673","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":85830.28,"maximum":173837.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":173837.0},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":93283.92},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":96145.21},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":85830.28},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":101977.03},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":118161.6},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":105187.06},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":98594.75}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Kidney And Urinary Tract Procedures With Cc","code_information":[{"code":"674","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":47772.92,"maximum":96757.24,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":96757.24},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":51921.6},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":53514.18},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":47772.92},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":56760.16},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":65768.45},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":58546.85},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":54877.59}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"1 through 10","median_amount":4770.48,"10th_percentile":4770.48,"90th_percentile":4770.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16183.47,"10th_percentile":16183.47,"90th_percentile":16183.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Kidney And Urinary Tract Procedures Without Cc/Mcc","code_information":[{"code":"675","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":33530.52,"maximum":67911.28,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":67911.28},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":36442.36},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":37560.16},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":33530.52},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":39838.42},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":46161.09},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":41092.45},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":38517.09}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Renal Failure With Mcc","code_information":[{"code":"682","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":30253.87,"maximum":61274.89,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":61274.89},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":32881.16},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":33889.72},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":30253.87},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":35945.35},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":41650.16},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37076.84},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34753.15}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"1 through 10","median_amount":32016.88,"10th_percentile":32016.88,"90th_percentile":32016.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7477.53,"10th_percentile":7477.53,"90th_percentile":7477.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Renal Failure With Cc","code_information":[{"code":"683","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17890.84,"maximum":36235.35,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":36235.35},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":19444.51},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":20040.93},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":17890.84},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":21256.54},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":24630.12},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21925.65},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20551.52}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7116.75,"10th_percentile":7116.75,"90th_percentile":7116.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6616.47,"10th_percentile":6394.92,"90th_percentile":6637.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Renal Failure Without Cc/Mcc","code_information":[{"code":"684","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12262.93,"maximum":24836.81,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24836.81},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":13327.86},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":13736.66},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":12262.93},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":14569.88},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":16882.24},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15028.51},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14086.64}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney And Urinary Tract Neoplasms With Mcc","code_information":[{"code":"686","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":36845.98,"maximum":74626.28,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":74626.28},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":40045.75},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":41274.07},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":36845.98},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":43777.6},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":50725.46},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":45155.63},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":42325.62}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney And Urinary Tract Neoplasms With Cc","code_information":[{"code":"687","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":21404.46,"maximum":43351.68,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":43351.68},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":23263.26},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":23976.81},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":21404.46},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":25431.15},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":29467.28},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26231.67},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24587.67}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney And Urinary Tract Neoplasms Without Cc/Mcc","code_information":[{"code":"688","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16144.25,"maximum":32697.87,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32697.87},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":17546.24},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":18084.43},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":16144.25},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":19181.37},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":22225.61},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19785.16},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18545.18}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney And Urinary Tract Infections With Mcc","code_information":[{"code":"689","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":23702.61,"maximum":48006.25,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":48006.25},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":25760.98},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":26551.14},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":23702.61},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":28161.64},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":32631.12},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29048.11},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27227.6}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":18426.2,"10th_percentile":18426.2,"90th_percentile":18426.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8545.02,"10th_percentile":8545.02,"90th_percentile":8545.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney And Urinary Tract Infections Without Mcc","code_information":[{"code":"690","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16536.47,"maximum":33492.25,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33492.25},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":17972.52},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":18523.79},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":16536.47},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":19647.37},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":22765.57},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20265.83},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18995.73}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"1 through 10","median_amount":12030.79,"10th_percentile":12030.79,"90th_percentile":12030.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"1 through 10","median_amount":14736.47,"10th_percentile":14736.47,"90th_percentile":14736.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6654.56,"10th_percentile":6654.56,"90th_percentile":6654.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5543.37,"10th_percentile":5543.37,"90th_percentile":5543.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5945.49,"10th_percentile":5945.49,"90th_percentile":5956.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":2630.92,"10th_percentile":2630.92,"90th_percentile":2630.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"1 through 10","median_amount":17708.62,"10th_percentile":17708.62,"90th_percentile":17708.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":4927.0,"10th_percentile":4927.0,"90th_percentile":4927.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Urinary Stones With Mcc","code_information":[{"code":"693","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":27465.45,"maximum":55627.34,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":55627.34},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":29850.59},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":30766.19},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":27465.45},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":32632.36},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":37811.37},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33659.56},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31550.04}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Urinary Stones Without Mcc","code_information":[{"code":"694","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15968.57,"maximum":32342.06,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32342.06},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":17355.3},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":17887.64},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":15968.57},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":18972.64},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":21983.75},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19569.86},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18343.37}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5527.98,"10th_percentile":5527.98,"90th_percentile":5527.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney And Urinary Tract Signs And Symptoms With Mcc","code_information":[{"code":"695","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":23365.55,"maximum":47323.58,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":47323.58},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":25394.65},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":26173.58},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":23365.55},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":27761.17},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":32167.09},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28635.03},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26840.41}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney And Urinary Tract Signs And Symptoms Without Mcc","code_information":[{"code":"696","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14074.89,"maximum":28506.69,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28506.69},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":15297.18},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":15766.39},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":14074.89},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":16722.72},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":19376.75},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17249.12},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16168.07}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Urethral Stricture","code_information":[{"code":"697","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":22017.3,"maximum":44592.9,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":44592.9},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":23929.32},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":24663.3},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":22017.3},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":26159.28},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":30310.97},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26982.72},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25291.65}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Kidney And Urinary Tract Diagnoses With Mcc","code_information":[{"code":"698","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":33796.08,"maximum":68449.15,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":68449.15},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":36730.99},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":37857.64},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":33796.08},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":40153.94},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":46526.69},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":41417.9},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":38822.15}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"1 through 10","median_amount":10097.67,"10th_percentile":10097.67,"90th_percentile":10097.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14392.18,"10th_percentile":14392.18,"90th_percentile":14392.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Kidney And Urinary Tract Diagnoses With Cc","code_information":[{"code":"699","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":20734.42,"maximum":41994.61,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":41994.61},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":22535.03},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":23226.25},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":20734.42},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":24635.07},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":28544.85},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25410.53},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23817.99}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"1 through 10","median_amount":22535.03,"10th_percentile":22535.03,"90th_percentile":22535.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7580.07,"10th_percentile":7580.07,"90th_percentile":7580.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Kidney And Urinary Tract Diagnoses Without Cc/Mcc","code_information":[{"code":"700","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14093.28,"maximum":28543.92,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28543.92},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":15317.16},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":15786.98},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":14093.28},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":16744.56},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":19402.06},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17271.65},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16189.19}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Male Pelvic Procedures With Cc/Mcc","code_information":[{"code":"707","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":40862.13,"maximum":82760.41,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":82760.41},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":44410.66},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":45772.86},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":40862.13},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":48549.28},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":56254.44},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":50077.51},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":46939.04}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Male Pelvic Procedures Without Cc/Mcc","code_information":[{"code":"708","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":31340.64,"maximum":63475.99,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":63475.99},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":34062.31},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":35107.1},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":31340.64},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":37236.57},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":43146.31},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":38408.7},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":36001.54}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Penis Procedures With Cc/Mcc","code_information":[{"code":"709","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":47538.0,"maximum":96281.44,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":96281.44},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":51666.27},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":53251.03},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":47538.0},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":56481.04},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":65445.03},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":58258.95},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":54607.73}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Penis Procedures Without Cc/Mcc","code_information":[{"code":"710","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":28623.71,"maximum":57973.25,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":57973.25},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":31109.44},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":32063.66},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":28623.71},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":34008.53},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":39405.95},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35079.04},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32880.56}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Testes Procedures With Cc/Mcc","code_information":[{"code":"711","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":42567.87,"maximum":86215.14,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":86215.14},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":46264.53},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":47683.6},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":42567.87},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":50575.91},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":58602.71},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":52167.93},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":48898.45}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Testes Procedures Without Cc/Mcc","code_information":[{"code":"712","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":22464.67,"maximum":45498.99,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":45498.99},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":24415.54},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":25164.44},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":22464.67},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":26690.82},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":30926.86},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27530.99},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25805.56}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Transurethral Prostatectomy With Cc/Mcc","code_information":[{"code":"713","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":30711.46,"maximum":62201.67,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":62201.67},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":33378.49},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":34402.3},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":30711.46},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":36489.02},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":42280.12},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37637.62},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35278.78}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10300.12,"10th_percentile":10300.12,"90th_percentile":10300.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Transurethral Prostatectomy Without Cc/Mcc","code_information":[{"code":"714","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":21600.57,"maximum":43748.87,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":43748.87},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":23476.39},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":24196.48},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":21600.57},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":25664.16},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":29737.26},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26472.01},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24812.95}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Male Reproductive System O.R. Procedures For Malignancy With Cc/Mcc","code_information":[{"code":"715","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":45703.56,"maximum":92566.05,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":92566.05},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":49672.53},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":51196.14},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":45703.56},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":54301.51},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":62919.59},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":56010.81},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":52500.48}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Male Reproductive System O.R. Procedures For Malignancy Without Cc/Mcc","code_information":[{"code":"716","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":30049.59,"maximum":60861.15,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":60861.15},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":32659.14},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":33660.89},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":30049.59},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":35702.64},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":41368.93},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":36826.49},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34518.49}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Male Reproductive System O.R. Procedures Except Malignancy With Cc/Mcc","code_information":[{"code":"717","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":38619.13,"maximum":78217.55,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":78217.55},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":41972.88},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":43260.31},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":38619.13},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":45884.33},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":53166.53},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":47328.67},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":44362.47}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Male Reproductive System O.R. Procedures Except Malignancy Without Cc/Mcc","code_information":[{"code":"718","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":27436.85,"maximum":55569.42,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":55569.42},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":29819.51},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":30734.16},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":27436.85},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":32598.38},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":37772.0},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33624.51},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31517.18}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Malignancy, Male Reproductive System With Mcc","code_information":[{"code":"722","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":36968.55,"maximum":74874.53,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":74874.53},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":40178.96},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":41411.37},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":36968.55},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":43923.23},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":50894.19},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":45305.84},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":42466.42}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Malignancy, Male Reproductive System With Cc","code_information":[{"code":"723","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":23343.08,"maximum":47278.07,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":47278.07},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":25370.23},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":26148.4},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":23343.08},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":27734.47},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":32136.15},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28607.49},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26814.6}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Malignancy, Male Reproductive System Without Cc/Mcc","code_information":[{"code":"724","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13394.64,"maximum":27128.93,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27128.93},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":14557.85},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":15004.38},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":13394.64},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":15914.49},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":18440.25},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16415.45},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15386.66}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Benign Prostatic Hypertrophy With Mcc","code_information":[{"code":"725","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":23904.85,"maximum":48415.85,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":48415.85},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":25980.78},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":26777.69},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":23904.85},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":28401.92},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":32909.53},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29295.96},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27459.91}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Benign Prostatic Hypertrophy Without Mcc","code_information":[{"code":"726","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14749.02,"maximum":29872.03,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29872.03},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":16029.84},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":16521.53},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":14749.02},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":17523.66},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":20304.81},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18075.27},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16942.45}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Inflammation Of The Male Reproductive System With Mcc","code_information":[{"code":"727","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":30292.68,"maximum":61353.5,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":61353.5},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":32923.35},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":33933.2},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":30292.68},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":35991.47},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":41703.6},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37124.4},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34797.73}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Inflammation Of The Male Reproductive System Without Mcc","code_information":[{"code":"728","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16571.19,"maximum":33562.59,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33562.59},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":18010.26},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":18562.69},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":16571.19},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":19688.64},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":22813.38},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20308.39},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19035.62}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"1 through 10","median_amount":2771.06,"10th_percentile":2771.06,"90th_percentile":2771.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Male Reproductive System Diagnoses With Cc/Mcc","code_information":[{"code":"729","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":21627.12,"maximum":43802.65,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":43802.65},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":23505.26},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":24226.23},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":21627.12},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":25695.71},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":29773.82},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26504.55},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24843.45}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Male Reproductive System Diagnoses Without Cc/Mcc","code_information":[{"code":"730","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13727.62,"maximum":27803.33,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27803.33},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":14919.74},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":15377.38},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":13727.62},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":16310.11},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":18898.66},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16823.52},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15769.15}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy With Cc/Mcc","code_information":[{"code":"734","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":43511.64,"maximum":88126.62,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":88126.62},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":47290.26},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":48740.79},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":43511.64},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":51697.23},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":59901.99},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":53324.55},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":49982.58}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy Without Cc/Mcc","code_information":[{"code":"735","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":27485.87,"maximum":55668.72,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":55668.72},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":29872.79},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":30789.08},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":27485.87},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":32656.63},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":37839.5},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33684.59},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31573.5}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Mcc","code_information":[{"code":"736","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":73019.89,"maximum":147891.36,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":147891.36},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":79361.05},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":81795.28},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":73019.89},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":86756.69},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":100525.66},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":89487.61},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":83879.22}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Cc","code_information":[{"code":"737","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":42093.94,"maximum":85255.26,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":85255.26},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":45749.44},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":47152.71},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":42093.94},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":50012.82},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":57950.25},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":51587.12},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":48354.04}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy Without Cc/Mcc","code_information":[{"code":"738","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":29998.52,"maximum":60757.72,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":60757.72},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":32603.64},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":33603.69},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":29998.52},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":35641.96},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":41298.63},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":36763.9},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34459.82}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With Mcc","code_information":[{"code":"739","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":73189.44,"maximum":148234.77,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":148234.77},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":79545.33},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":81985.21},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":73189.44},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":86958.14},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":100759.08},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":89695.4},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":84073.98}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With Cc","code_information":[{"code":"740","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":36966.51,"maximum":74870.39,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":74870.39},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":40176.74},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":41409.08},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":36966.51},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":43920.8},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":50891.38},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":45303.34},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":42464.07}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy Without Cc/Mcc","code_information":[{"code":"741","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":29132.37,"maximum":59003.46,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":59003.46},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":31662.27},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":32633.45},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":29132.37},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":34612.87},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":40106.21},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35702.41},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33464.86}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Uterine And Adnexa Procedures For Non-Malignancy With Cc/Mcc","code_information":[{"code":"742","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":37481.29,"maximum":75913.02,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":75913.02},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":40736.23},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":41985.73},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":37481.29},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":44532.43},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":51600.08},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":45934.22},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":43055.42}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"1 through 10","median_amount":45934.22,"10th_percentile":45934.22,"90th_percentile":45934.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Uterine And Adnexa Procedures For Non-Malignancy Without Cc/Mcc","code_information":[{"code":"743","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":25345.02,"maximum":51332.72,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":51332.72},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":27546.02},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":28390.94},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":25345.02},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":30113.03},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":34892.21},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31060.92},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29114.27}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":19565.26,"10th_percentile":19565.26,"90th_percentile":19565.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"D&C, Conization, Laparoscopy And Tubal Interruption With Cc/Mcc","code_information":[{"code":"744","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":41859.01,"maximum":84779.46,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":84779.46},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":45494.12},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":46889.56},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":41859.01},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":49733.71},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":57626.84},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":51299.22},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":48084.18}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"D&C, Conization, Laparoscopy And Tubal Interruption Without Cc/Mcc","code_information":[{"code":"745","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":23236.85,"maximum":47062.93,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":47062.93},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":25254.78},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":26029.41},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":23236.85},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":27608.26},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":31989.91},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28477.31},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26692.58}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Vagina, Cervix And Vulva Procedures With Cc/Mcc","code_information":[{"code":"746","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":35485.48,"maximum":71870.78,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":71870.78},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":38567.09},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":39750.06},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":35485.48},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":42161.15},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":48852.46},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":43488.3},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":40762.79}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Vagina, Cervix And Vulva Procedures Without Cc/Mcc","code_information":[{"code":"747","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17561.95,"maximum":35569.23,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35569.23},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":19087.06},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":19672.52},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":17561.95},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":20865.78},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":24177.34},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21522.59},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20173.72}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Female Reproductive System Reconstructive Procedures","code_information":[{"code":"748","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":28339.76,"maximum":57398.15,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":57398.15},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":30800.83},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":31745.59},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":28339.76},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":33671.16},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":39015.04},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34731.06},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32554.38}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Female Reproductive System O.R. Procedures With Cc/Mcc","code_information":[{"code":"749","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":52450.93,"maximum":106231.88,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":106231.88},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":57005.86},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":58754.39},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":52450.93},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":62318.22},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":72208.61},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":64279.87},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":60251.3}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Female Reproductive System O.R. Procedures Without Cc/Mcc","code_information":[{"code":"750","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":30147.64,"maximum":61059.75,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":61059.75},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":32765.71},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":33770.73},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":30147.64},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":35819.14},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":41503.92},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":36946.65},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34631.12}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Malignancy, Female Reproductive System With Mcc","code_information":[{"code":"754","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":37622.25,"maximum":76198.5,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":76198.5},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":40889.42},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":42143.62},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":37622.25},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":44699.9},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":51794.13},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":46106.96},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":43217.33}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Malignancy, Female Reproductive System With Cc","code_information":[{"code":"755","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":22221.58,"maximum":45006.64,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":45006.64},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":24151.34},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":24892.13},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":22221.58},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":26401.99},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":30592.2},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27233.07},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25526.31}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Malignancy, Female Reproductive System Without Cc/Mcc","code_information":[{"code":"756","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":19621.09,"maximum":39739.73,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":39739.73},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":21325.02},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":21979.12},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":19621.09},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":23312.3},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":27012.14},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24046.12},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22539.09}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Infections, Female Reproductive System With Mcc","code_information":[{"code":"757","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":29250.85,"maximum":59243.43,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":59243.43},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":31791.04},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":32766.17},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":29250.85},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":34753.64},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":40269.32},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35847.62},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33600.97}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Infections, Female Reproductive System With Cc","code_information":[{"code":"758","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":19999.01,"maximum":40505.15,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":40505.15},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":21735.76},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":22402.46},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":19999.01},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":23761.31},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":27532.42},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24509.27},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22973.21}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Infections, Female Reproductive System Without Cc/Mcc","code_information":[{"code":"759","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13556.02,"maximum":27455.79,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27455.79},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":14733.25},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":15185.16},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":13556.02},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":16106.24},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":18662.42},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16613.23},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15572.04}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Menstrual And Other Female Reproductive System Disorders With Cc/Mcc","code_information":[{"code":"760","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":20581.21,"maximum":41684.31,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":41684.31},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":22368.52},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":23054.62},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":20581.21},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":24453.03},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":28333.92},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25222.76},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23642.0}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"1 through 10","median_amount":39699.53,"10th_percentile":39699.53,"90th_percentile":39699.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"1 through 10","median_amount":25222.76,"10th_percentile":25222.76,"90th_percentile":25222.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Menstrual And Other Female Reproductive System Disorders Without Cc/Mcc","code_information":[{"code":"761","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11654.17,"maximum":23603.87,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23603.87},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":12666.24},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":13054.75},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":11654.17},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":13846.61},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":16044.17},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14282.47},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13387.35}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Vaginal Delivery With O.R. Procedures Except Sterilization And/Or D&C","code_information":[{"code":"768","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":21890.64,"maximum":44336.38,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":44336.38},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":23791.66},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":24521.42},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":21890.64},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":26008.8},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":30136.61},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26827.51},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25146.17}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":2635.56,"10th_percentile":2635.56,"90th_percentile":2635.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":2200.55,"10th_percentile":2200.55,"90th_percentile":2200.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Postpartum And Post Abortion Diagnoses With O.R. Procedures","code_information":[{"code":"769","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":34519.23,"maximum":69913.79,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":69913.79},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":37516.94},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":38667.69},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":34519.23},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":41013.14},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":47522.25},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":42304.14},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":39652.85}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Abortion With D&C, Aspiration Curettage Or Hysterotomy","code_information":[{"code":"770","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":20483.16,"maximum":41485.71,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":41485.71},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":22261.95},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":22944.78},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":20483.16},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":24336.53},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":28198.93},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25102.59},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23529.36}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Postpartum And Post Abortion Diagnoses Without O.R. Procedures","code_information":[{"code":"776","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13374.21,"maximum":27087.56,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27087.56},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":14535.65},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":14981.5},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":13374.21},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":15890.22},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":18412.13},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16390.41},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15363.19}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"1 through 10","median_amount":15543.87,"10th_percentile":15543.87,"90th_percentile":15543.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Abortion Without D&C","code_information":[{"code":"779","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17186.08,"maximum":34807.95,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34807.95},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":18678.54},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":19251.47},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":17186.08},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":20419.19},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":23659.88},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21061.95},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19741.95}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13432.13,"10th_percentile":13432.13,"90th_percentile":13432.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cesarean Section With Sterilization With Mcc","code_information":[{"code":"783","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":50152.78,"maximum":101577.31,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":101577.31},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":54508.13},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":56180.05},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":50152.78},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":59587.73},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":69044.78},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":61463.43},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":57611.38}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cesarean Section With Sterilization With Cc","code_information":[{"code":"784","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":21655.72,"maximum":43860.58,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":43860.58},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":23536.34},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":24258.27},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":21655.72},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":25729.69},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":29813.19},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26539.6},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24876.31}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cesarean Section With Sterilization Without Cc/Mcc","code_information":[{"code":"785","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":19565.94,"maximum":39628.02,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":39628.02},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":21265.08},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":21917.34},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":19565.94},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":23246.76},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":26936.21},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23978.52},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22475.73}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15734.29,"10th_percentile":15734.29,"90th_percentile":15734.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cesarean Section Without Sterilization With Mcc","code_information":[{"code":"786","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":33695.99,"maximum":68246.41,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":68246.41},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":36622.2},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":37745.51},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":33695.99},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":40035.01},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":46388.89},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":41295.23},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":38707.17}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"1 through 10","median_amount":25237.43,"10th_percentile":25237.43,"90th_percentile":25237.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":8879.41,"10th_percentile":8879.41,"90th_percentile":8879.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"1 through 10","median_amount":4146.29,"10th_percentile":4146.29,"90th_percentile":4146.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cesarean Section Without Sterilization With Cc","code_information":[{"code":"787","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":22813.99,"maximum":46206.48,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":46206.48},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":24795.19},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":25555.73},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":22813.99},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":27105.85},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":31407.77},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27959.09},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26206.83}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"1 through 10","median_amount":12522.0,"10th_percentile":12522.0,"90th_percentile":12522.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"1 through 10","median_amount":21200.75,"10th_percentile":21200.75,"90th_percentile":21200.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"1 through 10","median_amount":3244.65,"10th_percentile":3244.65,"90th_percentile":3244.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cesarean Section Without Sterilization Without Cc/Mcc","code_information":[{"code":"788","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":19586.37,"maximum":39669.39,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":39669.39},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":21287.28},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":21940.22},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":19586.37},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":23271.03},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":26964.33},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24003.56},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22499.2}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"1 through 10","median_amount":41382.31,"10th_percentile":41382.31,"90th_percentile":41382.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":3182.84,"10th_percentile":3182.84,"90th_percentile":3182.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":3245.4,"10th_percentile":3245.4,"90th_percentile":3245.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"1 through 10","median_amount":4146.29,"10th_percentile":4146.29,"90th_percentile":4146.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Neonates, Died Or Transferred To Another Acute Care Facility","code_information":[{"code":"789","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":36815.34,"maximum":74564.22,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":74564.22},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":40012.44},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":41239.74},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":36815.34},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":43741.2},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":50683.27},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":45118.08},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":42290.43}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"1 through 10","median_amount":972.71,"10th_percentile":972.71,"90th_percentile":972.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Extreme Immaturity Or Respiratory Distress Syndrome, Neonate","code_information":[{"code":"790","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":121413.82,"maximum":245906.37,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":245906.37},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":131957.59},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":136005.11},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":121413.82},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":144254.69},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":167149.05},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":148795.52},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":139470.17}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Prematurity With Major Problems","code_information":[{"code":"791","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":82917.25,"maximum":167937.07,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":167937.07},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":90117.92},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":92882.1},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":82917.25},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":98515.99},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":114151.26},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":101617.07},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":95248.49}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Prematurity Without Major Problems","code_information":[{"code":"792","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":50032.26,"maximum":101333.2,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":101333.2},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":54377.14},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":56045.04},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":50032.26},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":59444.53},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":68878.85},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":61315.72},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":57472.93}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":1854.06,"10th_percentile":1854.06,"90th_percentile":1854.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Full Term Neonate With Major Problems","code_information":[{"code":"793","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":85176.59,"maximum":172513.03,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":172513.03},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":92573.46},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":95412.96},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":85176.59},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":101200.36},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":117261.66},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":104385.94},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":97843.83}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":2963.85,"10th_percentile":2963.85,"90th_percentile":2963.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Neonate With Other Significant Problems","code_information":[{"code":"794","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":30149.69,"maximum":61063.89,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":61063.89},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":32767.93},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":33773.02},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":30149.69},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":35821.57},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":41506.74},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":36949.16},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34633.47}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":909.16,"10th_percentile":611.36,"90th_percentile":909.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":927.02,"10th_percentile":623.38,"90th_percentile":927.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":4094.55,"10th_percentile":4094.55,"90th_percentile":4094.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"1 through 10","median_amount":926.81,"10th_percentile":623.23,"90th_percentile":4849.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Normal Newborn","code_information":[{"code":"795","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4081.51,"maximum":8266.53,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8266.53},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":4435.96},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":4572.02},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":4081.51},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":4849.35},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":5618.98},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5001.99},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4688.51}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"1 through 10","median_amount":162.27,"10th_percentile":162.27,"90th_percentile":162.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"1 through 10","median_amount":623.23,"10th_percentile":623.23,"90th_percentile":623.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Vaginal Delivery With Sterilization And/Or D&C With Mcc","code_information":[{"code":"796","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":23839.48,"maximum":48283.46,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":48283.46},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":25909.73},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":26704.46},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":23839.48},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":28324.26},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":32819.54},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29215.85},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27384.82}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Vaginal Delivery With Sterilization And/Or D&C With Cc","code_information":[{"code":"797","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":20436.17,"maximum":41390.55,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":41390.55},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":22210.88},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":22892.15},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":20436.17},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":24280.71},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":28134.25},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25045.01},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23475.39}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Vaginal Delivery With Sterilization And/Or D&C Without Cc/Mcc","code_information":[{"code":"798","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":19551.64,"maximum":39599.06,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":39599.06},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":21249.53},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":21901.32},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":19551.64},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":23229.77},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":26916.52},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23961.0},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22459.31}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"1 through 10","median_amount":3222.16,"10th_percentile":3222.16,"90th_percentile":3222.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Splenic Procedures With Mcc","code_information":[{"code":"799","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":92516.37,"maximum":187378.71,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":187378.71},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":100550.64},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":103634.82},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":92516.37},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":109920.93},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":127366.25},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":113381.01},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":106275.17}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Splenic Procedures With Cc","code_information":[{"code":"800","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":57390.42,"maximum":116236.12,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":116236.12},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":62374.3},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":64287.5},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":57390.42},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":68186.95},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":79008.76},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":70333.33},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":65925.38}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Splenic Procedures Without Cc/Mcc","code_information":[{"code":"801","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":38995.01,"maximum":78978.83,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":78978.83},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":42381.4},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":43681.36},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":38995.01},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":46330.91},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":53683.99},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":47789.31},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":44794.25}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other O.R. Procedures Of The Blood And Blood Forming Organs With Mcc","code_information":[{"code":"802","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":81387.19,"maximum":164838.15,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":164838.15},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":88454.99},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":91168.16},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":81387.19},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":96698.09},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":112044.84},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":99741.94},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":93490.89}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other O.R. Procedures Of The Blood And Blood Forming Organs With Cc","code_information":[{"code":"803","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":37973.61,"maximum":76910.13,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":76910.13},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":41271.3},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":42537.21},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":37973.61},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":45117.36},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":52277.84},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":46537.56},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":43620.95}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other O.R. Procedures Of The Blood And Blood Forming Organs Without Cc/Mcc","code_information":[{"code":"804","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":27700.37,"maximum":56103.14,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":56103.14},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":30105.91},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":31029.35},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":27700.37},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":32911.48},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":38134.79},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33947.46},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31819.9}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Vaginal Delivery Without Sterilization Or D&C With Mcc","code_information":[{"code":"805","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":22045.9,"maximum":44650.82,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":44650.82},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":23960.4},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":24695.33},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":22045.9},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":26193.26},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":30350.34},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27017.77},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25324.51}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":18111.71,"10th_percentile":18111.71,"90th_percentile":18111.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Vaginal Delivery Without Sterilization Or D&C With Cc","code_information":[{"code":"806","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15402.71,"maximum":31196.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31196.0},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":16740.31},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":17253.78},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":15402.71},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":18300.33},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":21204.74},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18876.39},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17693.36}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"1 through 10","median_amount":16879.12,"10th_percentile":16879.12,"90th_percentile":16879.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":2240.18,"10th_percentile":2240.18,"90th_percentile":2240.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12604.78,"10th_percentile":12604.78,"90th_percentile":12604.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"1 through 10","median_amount":2239.66,"10th_percentile":2239.66,"90th_percentile":2239.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Vaginal Delivery Without Sterilization Or D&C Without Cc/Mcc","code_information":[{"code":"807","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13772.56,"maximum":27894.35,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27894.35},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":14968.59},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":15427.72},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":13772.56},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":16363.51},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":18960.53},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16878.6},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15820.78}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"1 through 10","median_amount":10019.96,"10th_percentile":10019.96,"90th_percentile":11858.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":1933.4,"10th_percentile":1933.4,"90th_percentile":1933.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"1 through 10","median_amount":8822.37,"10th_percentile":8822.37,"90th_percentile":14354.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"1 through 10","median_amount":11107.0,"10th_percentile":11107.0,"90th_percentile":11107.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":1896.57,"10th_percentile":1896.57,"90th_percentile":1896.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9824.56,"10th_percentile":9824.56,"90th_percentile":9824.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":1933.85,"10th_percentile":1933.85,"90th_percentile":2240.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11379.36,"10th_percentile":10866.15,"90th_percentile":11892.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"1 through 10","median_amount":1933.4,"10th_percentile":1933.4,"90th_percentile":2239.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders ","code_information":[{"code":"808","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":45102.98,"maximum":91349.65,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":91349.65},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":49019.8},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":50523.38},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":45102.98},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":53587.94},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":62092.77},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":55274.78},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":51810.58}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders ","code_information":[{"code":"809","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":25859.81,"maximum":52375.35,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":52375.35},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":28105.51},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":28967.59},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":25859.81},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":30724.66},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":35600.91},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31691.81},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29705.61}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders ","code_information":[{"code":"810","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":21379.94,"maximum":43302.03,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":43302.03},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":23236.61},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":23949.35},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":21379.94},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":25402.03},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":29433.53},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26201.63},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24559.52}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Red Blood Cell Disorders With Mcc","code_information":[{"code":"811","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":28687.04,"maximum":58101.51,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":58101.51},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":31178.27},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":32134.6},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":28687.04},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":34083.77},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":39493.13},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35156.65},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32953.3}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Red Blood Cell Disorders Without Mcc","code_information":[{"code":"812","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":18756.99,"maximum":37989.61,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37989.61},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":20385.88},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":21011.17},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":18756.99},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":22285.63},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":25822.54},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22987.14},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21546.48}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":2419.01,"10th_percentile":2419.01,"90th_percentile":2419.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"1 through 10","median_amount":17092.35,"10th_percentile":17092.35,"90th_percentile":17092.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":3254.59,"10th_percentile":3254.59,"90th_percentile":3254.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"1 through 10","median_amount":2419.01,"10th_percentile":2419.01,"90th_percentile":2419.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Coagulation Disorders","code_information":[{"code":"813","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":31158.83,"maximum":63107.76,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":63107.76},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":33864.71},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":34903.44},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":31158.83},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":37020.56},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":42896.01},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":38185.89},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35792.69}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Reticuloendothelial And Immunity Disorders With Mcc","code_information":[{"code":"814","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":43444.23,"maximum":87990.09,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":87990.09},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":47216.99},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":48665.28},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":43444.23},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":51617.14},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":59809.18},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":53241.93},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":49905.14}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Reticuloendothelial And Immunity Disorders With Cc","code_information":[{"code":"815","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":20713.99,"maximum":41953.24,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":41953.24},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":22512.83},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":23203.36},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":20713.99},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":24610.79},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":28516.72},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25385.49},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23794.52}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Reticuloendothelial And Immunity Disorders Without Cc/Mcc","code_information":[{"code":"816","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12910.5,"maximum":26148.37,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26148.37},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":14031.66},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":14462.06},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":12910.5},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":15339.27},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":17773.74},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15822.12},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14830.51}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Antepartum Diagnoses With O.R. Procedures With Mcc","code_information":[{"code":"817","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":46608.52,"maximum":94398.92,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":94398.92},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":50656.08},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":52209.85},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":46608.52},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":55376.71},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":64165.44},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":57119.86},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":53540.03}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Antepartum Diagnoses With O.R. Procedures With Cc","code_information":[{"code":"818","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":23680.14,"maximum":47960.74,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":47960.74},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":25736.56},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":26525.97},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":23680.14},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":28134.94},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":32600.18},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29020.57},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27201.79}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Antepartum Diagnoses With O.R. Procedures Without Cc/Mcc","code_information":[{"code":"819","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17566.04,"maximum":35577.5,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35577.5},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":19091.5},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":19677.09},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":17566.04},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":20870.63},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":24182.97},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21527.6},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20178.41}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lymphoma And Leukemia With Major O.R. Procedures With Mcc","code_information":[{"code":"820","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":119806.13,"maximum":242650.24,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":242650.24},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":130210.29},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":134204.22},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":119806.13},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":142344.56},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":164935.77},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":146825.27},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":137623.4}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lymphoma And Leukemia With Major O.R. Procedures With Cc","code_information":[{"code":"821","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":45730.12,"maximum":92619.84,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":92619.84},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":49701.4},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":51225.88},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":45730.12},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":54333.06},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":62956.15},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":56043.35},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":52530.99}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lymphoma And Leukemia With Major O.R. Procedures Without Cc/Mcc","code_information":[{"code":"822","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":24595.31,"maximum":49814.3,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":49814.3},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":26731.21},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":27551.13},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":24595.31},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":29222.28},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":33860.09},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30142.14},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28253.06}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lymphoma And Non-Acute Leukemia With Other Procedures With Mcc","code_information":[{"code":"823","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":93658.29,"maximum":189691.52,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":189691.52},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":101791.73},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":104913.98},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":93658.29},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":111277.68},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":128938.33},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":114780.47},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":107586.92}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lymphoma And Non-Acute Leukemia With Other Procedures With Cc","code_information":[{"code":"824","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":46281.68,"maximum":93736.93,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":93736.93},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":50300.85},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":51843.72},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":46281.68},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":54988.38},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":63715.47},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":56719.3},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":53164.57}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lymphoma And Non-Acute Leukemia With Other Procedures Without Cc/Mcc","code_information":[{"code":"825","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":27565.54,"maximum":55830.08,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":55830.08},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":29959.38},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":30878.32},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":27565.54},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":32751.29},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":37949.18},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33782.23},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31665.02}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With Mcc","code_information":[{"code":"826","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":95558.1,"maximum":193539.3,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":193539.3},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":103856.52},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":107042.1},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":95558.1},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":113534.88},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":131553.77},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":117108.72},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":109769.25}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With Cc","code_information":[{"code":"827","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":47213.19,"maximum":95623.59,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":95623.59},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":51313.26},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":52887.19},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":47213.19},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":56095.14},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":64997.88},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":57860.89},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":54234.62}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures Without C","code_information":[{"code":"828","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":34805.23,"maximum":70493.02,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":70493.02},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":37827.77},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":38988.06},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":34805.23},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":41352.93},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":47915.97},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":42654.63},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":39981.37}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures With Cc/Mcc","code_information":[{"code":"829","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":64552.48,"maximum":130741.84,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":130741.84},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":70158.32},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":72310.28},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":64552.48},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":76696.36},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":88868.68},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":79110.6},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":74152.56}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures Without Cc/Mcc","code_information":[{"code":"830","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":30744.14,"maximum":62267.87,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":62267.87},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":33414.01},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":34438.92},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":30744.14},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":36527.86},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":42325.12},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37677.68},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35316.33}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Antepartum Diagnoses Without O.R. Procedures With Mcc","code_information":[{"code":"831","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":24564.67,"maximum":49752.24,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":49752.24},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":26697.91},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":27516.81},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":24564.67},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":29185.88},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":33817.91},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30104.59},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28217.87}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Antepartum Diagnoses Without O.R. Procedures With Cc","code_information":[{"code":"832","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14740.84,"maximum":29855.48,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29855.48},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":16020.96},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":16512.37},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":14740.84},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":17513.95},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":20293.56},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18065.26},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16933.07}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"1 through 10","median_amount":15515.32,"10th_percentile":15515.32,"90th_percentile":15515.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":2409.72,"10th_percentile":2409.72,"90th_percentile":2409.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"1 through 10","median_amount":2456.51,"10th_percentile":2456.51,"90th_percentile":2456.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Antepartum Diagnoses Without O.R. Procedures Without Cc/Mcc","code_information":[{"code":"833","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10681.8,"maximum":21634.46,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21634.46},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":11609.43},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":11965.52},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":10681.8},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":12691.31},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":14705.52},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13090.8},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12270.37}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute Leukemia With Mcc","code_information":[{"code":"834","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":112147.68,"maximum":227139.12,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":227139.12},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":121886.76},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":125625.38},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":112147.68},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":133245.36},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":154392.46},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":137439.65},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":128825.99}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute Leukemia With Cc","code_information":[{"code":"835","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":42608.72,"maximum":86297.89,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":86297.89},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":46308.93},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":47729.36},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":42608.72},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":50624.45},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":58658.95},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":52218.0},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":48945.38}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute Leukemia Without Cc/Mcc","code_information":[{"code":"836","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":24911.95,"maximum":50455.59,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":50455.59},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":27075.34},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":27905.82},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":24911.95},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":29598.48},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":34296.0},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30530.18},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28616.79}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Chemotherapy With Acute Leukemia As Secondary Diagnosis Or With High Dose Chemotherapy Agent With Mc","code_information":[{"code":"837","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":98142.24,"maximum":198773.11,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":198773.11},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":106665.07},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":109936.8},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":98142.24},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":116605.17},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":135111.33},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":120275.65},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":112737.7}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Chemotherapy With Acute Leukemia As Secondary Diagnosis With Cc Or High Dose Chemotherapy Agent","code_information":[{"code":"838","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":42641.41,"maximum":86364.09,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":86364.09},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":46344.45},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":47765.97},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":42641.41},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":50663.29},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":58703.95},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":52258.06},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":48982.93}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Chemotherapy With Acute Leukemia As Secondary Diagnosis Without Cc/Mcc","code_information":[{"code":"839","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":29495.99,"maximum":59739.92,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":59739.92},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":32057.47},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":33040.76},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":29495.99},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":35044.9},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":40606.8},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":36148.04},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33882.56}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lymphoma And Non-Acute Leukemia With Mcc","code_information":[{"code":"840","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":66082.54,"maximum":133840.75,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":133840.75},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":71821.25},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":74024.22},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":66082.54},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":78514.26},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":90975.09},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":80985.72},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":75910.16}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lymphoma And Non-Acute Leukemia With Cc","code_information":[{"code":"841","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":33326.24,"maximum":67497.54,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":67497.54},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":36220.34},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":37331.33},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":33326.24},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":39595.71},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":45879.86},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":40842.1},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":38282.43}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lymphoma And Non-Acute Leukemia Without Cc/Mcc","code_information":[{"code":"842","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":20640.45,"maximum":41804.29,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":41804.29},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":22432.9},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":23120.98},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":20640.45},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":24523.42},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":28415.48},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25295.36},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23710.05}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With Mcc","code_information":[{"code":"843","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":40749.77,"maximum":82532.86,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":82532.86},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":44288.55},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":45647.01},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":40749.77},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":48415.79},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":56099.76},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":49939.82},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":46809.98}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":33198.01,"10th_percentile":33198.01,"90th_percentile":33198.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With Cc","code_information":[{"code":"844","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":24869.05,"maximum":50368.71,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":50368.71},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":27028.71},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":27857.76},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":24869.05},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":29547.52},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":34236.94},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30477.61},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28567.51}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses Without Cc/Mcc","code_information":[{"code":"845","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17396.48,"maximum":35234.1,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35234.1},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":18907.22},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":19487.16},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":17396.48},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":20669.18},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":23949.55},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21319.81},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19983.65}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Chemotherapy Without Acute Leukemia As Secondary Diagnosis With Mcc","code_information":[{"code":"846","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":52959.59,"maximum":107262.1,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":107262.1},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":57558.69},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":59324.18},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":52959.59},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":62922.57},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":72908.88},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":64903.24},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":60835.61}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ketorolac tromethamine inj","code_information":[{"code":"0764","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 33.9] [Cardiac Cath (%BC): 33.9] [Observation (%BC): 57.7] [Emergency Department (%BC): 57.7] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 33.9] [Occupational Therapy (%BC): 33.9] [Physical Therapy (%BC): 33.9] [Respiratory Services/Therapy  (%BC): 33.9] [Speech Therapy (%BC): 33.9] [All Other OP (%BC): 33.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Avmed","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Baycare Plus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 30.92] [Cardiac Cath (%BC): 30.92] [Lithotripsy (%BC): 30.92] [PTCA (%BC): 30.92] [Observation (%BC): 47.84] [Emergency Department (%BC): 47.84] [Other Cardiac Testing (%BC): 41.01] [EEG (%BC): 41.01] [Chemotherapy (%BC): 41.01] [Nuclear Medicine (%BC): 15.94] [Radiation Therapy  (%BC): 41.01] [CT OP Scan (%BC): 15.94] [MRI OP (%BC): 15.94] [Positron Emission Tomography (%BC): 15.94] [Radiology (%BC): 15.94] [Laboratory (%BC): 41.01] [Occupational Therapy (%BC): 41.01] [Physical Therapy (%BC): 41.01] [Speech Therapy (%BC): 41.01] [Other Outpatient Implant (%BC): 24.52] [IV Therapy (%BC): 41.01] [All Other OP (%BC): 41.01]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50] [All Other OP (%BC): 16.218]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 45.89] [Cardiac Cath (%BC): 45.89] [Lithotripsy (%BC): 45.89] [PTCA (%BC): 45.89] [Observation (%BC): 55.14] [Emergency Department (%BC): 55.14] [Other Cardiac Testing (%BC): 50.30] [EEG (%BC): 50.30] [Chemotherapy (%BC): 50.30] [Nuclear Medicine (%BC): 18.93] [Radiation Therapy  (%BC): 50.30] [CT OP Scan (%BC): 18.93] [MRI OP (%BC): 18.93] [Positron Emission Tomography (%BC): 18.93] [Radiology (%BC): 18.93] [Laboratory (%BC): 50.30] [Occupational Therapy (%BC): 50.30] [Physical Therapy (%BC): 50.30] [Speech Therapy (%BC): 50.30] [Other Outpatient Implant (%BC): 24.52] [IV Therapy (%BC): 50.30] [All Other OP (%BC): 50.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 27.6] [Cardiac Cath (%BC): 27.6] [Observation (%BC): 42.8] [Emergency Department (%BC): 42.8] [Occupational Therapy (%BC): 27.6] [Physical Therapy (%BC): 27.6] [Respiratory Services/Therapy  (%BC): 27.6] [Speech Therapy (%BC): 27.6] [All Other OP (%BC): 27.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":3.12,"10th_percentile":3.12,"90th_percentile":3.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 60.4] [Cardiac Cath (%BC): 60.4] [Observation (%BC): 53.7] [Emergency Department (%BC): 53.7] [Occupational Therapy (%BC): 60.4] [Physical Therapy (%BC): 60.4] [Respiratory Services/Therapy  (%BC): 60.4] [Speech Therapy (%BC): 60.4] [All Other OP (%BC): 60.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Clinic Visits and Related Services","code_information":[{"code":"5012","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 33.9] [Cardiac Cath (%BC): 33.9] [Observation (%BC): 57.7] [Emergency Department (%BC): 57.7] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 33.9] [Occupational Therapy (%BC): 33.9] [Physical Therapy (%BC): 33.9] [Respiratory Services/Therapy  (%BC): 33.9] [Speech Therapy (%BC): 33.9] [All Other OP (%BC): 33.9]","count":"1 through 10","median_amount":134.43,"10th_percentile":134.43,"90th_percentile":1071.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Avmed","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Baycare Plus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 30.92] [Cardiac Cath (%BC): 30.92] [Lithotripsy (%BC): 30.92] [PTCA (%BC): 30.92] [Observation (%BC): 47.84] [Emergency Department (%BC): 47.84] [Other Cardiac Testing (%BC): 41.01] [EEG (%BC): 41.01] [Chemotherapy (%BC): 41.01] [Nuclear Medicine (%BC): 15.94] [Radiation Therapy  (%BC): 41.01] [CT OP Scan (%BC): 15.94] [MRI OP (%BC): 15.94] [Positron Emission Tomography (%BC): 15.94] [Radiology (%BC): 15.94] [Laboratory (%BC): 41.01] [Occupational Therapy (%BC): 41.01] [Physical Therapy (%BC): 41.01] [Speech Therapy (%BC): 41.01] [Other Outpatient Implant (%BC): 24.52] [IV Therapy (%BC): 41.01] [All Other OP (%BC): 41.01]","count":"1 through 10","median_amount":732.62,"10th_percentile":732.62,"90th_percentile":732.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50] [All Other OP (%BC): 16.218]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 45.89] [Cardiac Cath (%BC): 45.89] [Lithotripsy (%BC): 45.89] [PTCA (%BC): 45.89] [Observation (%BC): 55.14] [Emergency Department (%BC): 55.14] [Other Cardiac Testing (%BC): 50.30] [EEG (%BC): 50.30] [Chemotherapy (%BC): 50.30] [Nuclear Medicine (%BC): 18.93] [Radiation Therapy  (%BC): 50.30] [CT OP Scan (%BC): 18.93] [MRI OP (%BC): 18.93] [Positron Emission Tomography (%BC): 18.93] [Radiology (%BC): 18.93] [Laboratory (%BC): 50.30] [Occupational Therapy (%BC): 50.30] [Physical Therapy (%BC): 50.30] [Speech Therapy (%BC): 50.30] [Other Outpatient Implant (%BC): 24.52] [IV Therapy (%BC): 50.30] [All Other OP (%BC): 50.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 27.6] [Cardiac Cath (%BC): 27.6] [Observation (%BC): 42.8] [Emergency Department (%BC): 42.8] [Occupational Therapy (%BC): 27.6] [Physical Therapy (%BC): 27.6] [Respiratory Services/Therapy  (%BC): 27.6] [Speech Therapy (%BC): 27.6] [All Other OP (%BC): 27.6]","count":"1 through 10","median_amount":487.55,"10th_percentile":487.55,"90th_percentile":487.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"First Health/Coventry","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":166.13,"10th_percentile":166.13,"90th_percentile":166.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":4853.03,"10th_percentile":4853.03,"90th_percentile":4853.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":221.55,"10th_percentile":221.55,"90th_percentile":221.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":287.18,"10th_percentile":287.18,"90th_percentile":287.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"13","median_amount":169.35,"10th_percentile":119.81,"90th_percentile":307.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 60.4] [Cardiac Cath (%BC): 60.4] [Observation (%BC): 53.7] [Emergency Department (%BC): 53.7] [Occupational Therapy (%BC): 60.4] [Physical Therapy (%BC): 60.4] [Respiratory Services/Therapy  (%BC): 60.4] [Speech Therapy (%BC): 60.4] [All Other OP (%BC): 60.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Type A ED Visits","code_information":[{"code":"5021","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 33.9] [Cardiac Cath (%BC): 33.9] [Observation (%BC): 57.7] [Emergency Department (%BC): 57.7] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 33.9] [Occupational Therapy (%BC): 33.9] [Physical Therapy (%BC): 33.9] [Respiratory Services/Therapy  (%BC): 33.9] [Speech Therapy (%BC): 33.9] [All Other OP (%BC): 33.9]","count":"1 through 10","median_amount":812.71,"10th_percentile":812.71,"90th_percentile":812.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":82.6,"10th_percentile":82.6,"90th_percentile":82.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":85.0,"10th_percentile":85.0,"90th_percentile":85.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Avmed","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Baycare Plus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 30.92] [Cardiac Cath (%BC): 30.92] [Lithotripsy (%BC): 30.92] [PTCA (%BC): 30.92] [Observation (%BC): 47.84] [Emergency Department (%BC): 47.84] [Other Cardiac Testing (%BC): 41.01] [EEG (%BC): 41.01] [Chemotherapy (%BC): 41.01] [Nuclear Medicine (%BC): 15.94] [Radiation Therapy  (%BC): 41.01] [CT OP Scan (%BC): 15.94] [MRI OP (%BC): 15.94] [Positron Emission Tomography (%BC): 15.94] [Radiology (%BC): 15.94] [Laboratory (%BC): 41.01] [Occupational Therapy (%BC): 41.01] [Physical Therapy (%BC): 41.01] [Speech Therapy (%BC): 41.01] [Other Outpatient Implant (%BC): 24.52] [IV Therapy (%BC): 41.01] [All Other OP (%BC): 41.01]","count":"1 through 10","median_amount":156.26,"10th_percentile":156.26,"90th_percentile":329.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50] [All Other OP (%BC): 16.218]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 45.89] [Cardiac Cath (%BC): 45.89] [Lithotripsy (%BC): 45.89] [PTCA (%BC): 45.89] [Observation (%BC): 55.14] [Emergency Department (%BC): 55.14] [Other Cardiac Testing (%BC): 50.30] [EEG (%BC): 50.30] [Chemotherapy (%BC): 50.30] [Nuclear Medicine (%BC): 18.93] [Radiation Therapy  (%BC): 50.30] [CT OP Scan (%BC): 18.93] [MRI OP (%BC): 18.93] [Positron Emission Tomography (%BC): 18.93] [Radiology (%BC): 18.93] [Laboratory (%BC): 50.30] [Occupational Therapy (%BC): 50.30] [Physical Therapy (%BC): 50.30] [Speech Therapy (%BC): 50.30] [Other Outpatient Implant (%BC): 24.52] [IV Therapy (%BC): 50.30] [All Other OP (%BC): 50.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 27.6] [Cardiac Cath (%BC): 27.6] [Observation (%BC): 42.8] [Emergency Department (%BC): 42.8] [Occupational Therapy (%BC): 27.6] [Physical Therapy (%BC): 27.6] [Respiratory Services/Therapy  (%BC): 27.6] [Speech Therapy (%BC): 27.6] [All Other OP (%BC): 27.6]","count":"1 through 10","median_amount":154.79,"10th_percentile":154.79,"90th_percentile":154.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"First Health/Coventry","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":93.25,"10th_percentile":93.25,"90th_percentile":93.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":88.38,"10th_percentile":88.38,"90th_percentile":88.38,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":161.38,"10th_percentile":161.38,"90th_percentile":161.38,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":116.36,"10th_percentile":116.36,"90th_percentile":116.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":93.68,"10th_percentile":93.68,"90th_percentile":93.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":354.21,"10th_percentile":354.21,"90th_percentile":354.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":102.98,"10th_percentile":102.98,"90th_percentile":168.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 60.4] [Cardiac Cath (%BC): 60.4] [Observation (%BC): 53.7] [Emergency Department (%BC): 53.7] [Occupational Therapy (%BC): 60.4] [Physical Therapy (%BC): 60.4] [Respiratory Services/Therapy  (%BC): 60.4] [Speech Therapy (%BC): 60.4] [All Other OP (%BC): 60.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":92.8,"10th_percentile":92.8,"90th_percentile":92.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Type A ED Visits","code_information":[{"code":"5022","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 33.9] [Cardiac Cath (%BC): 33.9] [Observation (%BC): 57.7] [Emergency Department (%BC): 57.7] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 33.9] [Occupational Therapy (%BC): 33.9] [Physical Therapy (%BC): 33.9] [Respiratory Services/Therapy  (%BC): 33.9] [Speech Therapy (%BC): 33.9] [All Other OP (%BC): 33.9]","count":"1 through 10","median_amount":524.41,"10th_percentile":314.47,"90th_percentile":908.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":111.11,"10th_percentile":79.37,"90th_percentile":191.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":164.81,"10th_percentile":164.81,"90th_percentile":164.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Avmed","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Baycare Plus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 30.92] [Cardiac Cath (%BC): 30.92] [Lithotripsy (%BC): 30.92] [PTCA (%BC): 30.92] [Observation (%BC): 47.84] [Emergency Department (%BC): 47.84] [Other Cardiac Testing (%BC): 41.01] [EEG (%BC): 41.01] [Chemotherapy (%BC): 41.01] [Nuclear Medicine (%BC): 15.94] [Radiation Therapy  (%BC): 41.01] [CT OP Scan (%BC): 15.94] [MRI OP (%BC): 15.94] [Positron Emission Tomography (%BC): 15.94] [Radiology (%BC): 15.94] [Laboratory (%BC): 41.01] [Occupational Therapy (%BC): 41.01] [Physical Therapy (%BC): 41.01] [Speech Therapy (%BC): 41.01] [Other Outpatient Implant (%BC): 24.52] [IV Therapy (%BC): 41.01] [All Other OP (%BC): 41.01]","count":"1 through 10","median_amount":410.99,"10th_percentile":395.81,"90th_percentile":585.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50] [All Other OP (%BC): 16.218]","count":"1 through 10","median_amount":162.14,"10th_percentile":162.14,"90th_percentile":162.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 45.89] [Cardiac Cath (%BC): 45.89] [Lithotripsy (%BC): 45.89] [PTCA (%BC): 45.89] [Observation (%BC): 55.14] [Emergency Department (%BC): 55.14] [Other Cardiac Testing (%BC): 50.30] [EEG (%BC): 50.30] [Chemotherapy (%BC): 50.30] [Nuclear Medicine (%BC): 18.93] [Radiation Therapy  (%BC): 50.30] [CT OP Scan (%BC): 18.93] [MRI OP (%BC): 18.93] [Positron Emission Tomography (%BC): 18.93] [Radiology (%BC): 18.93] [Laboratory (%BC): 50.30] [Occupational Therapy (%BC): 50.30] [Physical Therapy (%BC): 50.30] [Speech Therapy (%BC): 50.30] [Other Outpatient Implant (%BC): 24.52] [IV Therapy (%BC): 50.30] [All Other OP (%BC): 50.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 27.6] [Cardiac Cath (%BC): 27.6] [Observation (%BC): 42.8] [Emergency Department (%BC): 42.8] [Occupational Therapy (%BC): 27.6] [Physical Therapy (%BC): 27.6] [Respiratory Services/Therapy  (%BC): 27.6] [Speech Therapy (%BC): 27.6] [All Other OP (%BC): 27.6]","count":"1 through 10","median_amount":397.17,"10th_percentile":397.17,"90th_percentile":690.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"First Health/Coventry","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"18","median_amount":113.04,"10th_percentile":72.25,"90th_percentile":154.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":158.58,"10th_percentile":158.58,"90th_percentile":158.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":290.26,"10th_percentile":290.26,"90th_percentile":290.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"14","median_amount":141.21,"10th_percentile":94.38,"90th_percentile":231.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"12","median_amount":352.89,"10th_percentile":352.89,"90th_percentile":352.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"40","median_amount":115.24,"10th_percentile":81.39,"90th_percentile":199.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 60.4] [Cardiac Cath (%BC): 60.4] [Observation (%BC): 53.7] [Emergency Department (%BC): 53.7] [Occupational Therapy (%BC): 60.4] [Physical Therapy (%BC): 60.4] [Respiratory Services/Therapy  (%BC): 60.4] [Speech Therapy (%BC): 60.4] [All Other OP (%BC): 60.4]","count":"1 through 10","median_amount":488.06,"10th_percentile":488.06,"90th_percentile":488.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":165.87,"10th_percentile":165.87,"90th_percentile":165.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 3 Type A ED Visits","code_information":[{"code":"5023","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 33.9] [Cardiac Cath (%BC): 33.9] [Observation (%BC): 57.7] [Emergency Department (%BC): 57.7] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 33.9] [Occupational Therapy (%BC): 33.9] [Physical Therapy (%BC): 33.9] [Respiratory Services/Therapy  (%BC): 33.9] [Speech Therapy (%BC): 33.9] [All Other OP (%BC): 33.9]","count":"26","median_amount":1924.54,"10th_percentile":931.02,"90th_percentile":2657.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"11","median_amount":125.54,"10th_percentile":111.11,"90th_percentile":184.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"11","median_amount":285.78,"10th_percentile":284.78,"90th_percentile":286.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Avmed","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Baycare Plus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":277.94,"10th_percentile":277.94,"90th_percentile":277.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 30.92] [Cardiac Cath (%BC): 30.92] [Lithotripsy (%BC): 30.92] [PTCA (%BC): 30.92] [Observation (%BC): 47.84] [Emergency Department (%BC): 47.84] [Other Cardiac Testing (%BC): 41.01] [EEG (%BC): 41.01] [Chemotherapy (%BC): 41.01] [Nuclear Medicine (%BC): 15.94] [Radiation Therapy  (%BC): 41.01] [CT OP Scan (%BC): 15.94] [MRI OP (%BC): 15.94] [Positron Emission Tomography (%BC): 15.94] [Radiology (%BC): 15.94] [Laboratory (%BC): 41.01] [Occupational Therapy (%BC): 41.01] [Physical Therapy (%BC): 41.01] [Speech Therapy (%BC): 41.01] [Other Outpatient Implant (%BC): 24.52] [IV Therapy (%BC): 41.01] [All Other OP (%BC): 41.01]","count":"38","median_amount":1648.05,"10th_percentile":853.18,"90th_percentile":2410.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50] [All Other OP (%BC): 16.218]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 45.89] [Cardiac Cath (%BC): 45.89] [Lithotripsy (%BC): 45.89] [PTCA (%BC): 45.89] [Observation (%BC): 55.14] [Emergency Department (%BC): 55.14] [Other Cardiac Testing (%BC): 50.30] [EEG (%BC): 50.30] [Chemotherapy (%BC): 50.30] [Nuclear Medicine (%BC): 18.93] [Radiation Therapy  (%BC): 50.30] [CT OP Scan (%BC): 18.93] [MRI OP (%BC): 18.93] [Positron Emission Tomography (%BC): 18.93] [Radiology (%BC): 18.93] [Laboratory (%BC): 50.30] [Occupational Therapy (%BC): 50.30] [Physical Therapy (%BC): 50.30] [Speech Therapy (%BC): 50.30] [Other Outpatient Implant (%BC): 24.52] [IV Therapy (%BC): 50.30] [All Other OP (%BC): 50.30]","count":"1 through 10","median_amount":1529.61,"10th_percentile":1529.61,"90th_percentile":1529.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":276.56,"10th_percentile":276.56,"90th_percentile":276.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 27.6] [Cardiac Cath (%BC): 27.6] [Observation (%BC): 42.8] [Emergency Department (%BC): 42.8] [Occupational Therapy (%BC): 27.6] [Physical Therapy (%BC): 27.6] [Respiratory Services/Therapy  (%BC): 27.6] [Speech Therapy (%BC): 27.6] [All Other OP (%BC): 27.6]","count":"39","median_amount":1536.0,"10th_percentile":906.21,"90th_percentile":2066.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"First Health/Coventry","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"45","median_amount":138.28,"10th_percentile":90.03,"90th_percentile":195.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"12","median_amount":275.18,"10th_percentile":274.88,"90th_percentile":412.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":507.52,"10th_percentile":507.52,"90th_percentile":507.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"62","median_amount":147.49,"10th_percentile":115.31,"90th_percentile":246.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"43","median_amount":617.03,"10th_percentile":617.03,"90th_percentile":933.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"118","median_amount":119.32,"10th_percentile":105.33,"90th_percentile":246.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 60.4] [Cardiac Cath (%BC): 60.4] [Observation (%BC): 53.7] [Emergency Department (%BC): 53.7] [Occupational Therapy (%BC): 60.4] [Physical Therapy (%BC): 60.4] [Respiratory Services/Therapy  (%BC): 60.4] [Speech Therapy (%BC): 60.4] [All Other OP (%BC): 60.4]","count":"11","median_amount":1952.35,"10th_percentile":1034.78,"90th_percentile":2554.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"13","median_amount":288.2,"10th_percentile":288.2,"90th_percentile":288.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":307.26,"10th_percentile":307.26,"90th_percentile":307.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 4 Type A ED Visits","code_information":[{"code":"5024","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 33.9] [Cardiac Cath (%BC): 33.9] [Observation (%BC): 57.7] [Emergency Department (%BC): 57.7] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 33.9] [Occupational Therapy (%BC): 33.9] [Physical Therapy (%BC): 33.9] [Respiratory Services/Therapy  (%BC): 33.9] [Speech Therapy (%BC): 33.9] [All Other OP (%BC): 33.9]","count":"18","median_amount":2992.37,"10th_percentile":1864.65,"90th_percentile":3642.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":163.3,"10th_percentile":107.99,"90th_percentile":346.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":438.44,"10th_percentile":438.14,"90th_percentile":438.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Avmed","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Baycare Plus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 30.92] [Cardiac Cath (%BC): 30.92] [Lithotripsy (%BC): 30.92] [PTCA (%BC): 30.92] [Observation (%BC): 47.84] [Emergency Department (%BC): 47.84] [Other Cardiac Testing (%BC): 41.01] [EEG (%BC): 41.01] [Chemotherapy (%BC): 41.01] [Nuclear Medicine (%BC): 15.94] [Radiation Therapy  (%BC): 41.01] [CT OP Scan (%BC): 15.94] [MRI OP (%BC): 15.94] [Positron Emission Tomography (%BC): 15.94] [Radiology (%BC): 15.94] [Laboratory (%BC): 41.01] [Occupational Therapy (%BC): 41.01] [Physical Therapy (%BC): 41.01] [Speech Therapy (%BC): 41.01] [Other Outpatient Implant (%BC): 24.52] [IV Therapy (%BC): 41.01] [All Other OP (%BC): 41.01]","count":"26","median_amount":2132.15,"10th_percentile":1647.44,"90th_percentile":3486.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50] [All Other OP (%BC): 16.218]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 45.89] [Cardiac Cath (%BC): 45.89] [Lithotripsy (%BC): 45.89] [PTCA (%BC): 45.89] [Observation (%BC): 55.14] [Emergency Department (%BC): 55.14] [Other Cardiac Testing (%BC): 50.30] [EEG (%BC): 50.30] [Chemotherapy (%BC): 50.30] [Nuclear Medicine (%BC): 18.93] [Radiation Therapy  (%BC): 50.30] [CT OP Scan (%BC): 18.93] [MRI OP (%BC): 18.93] [Positron Emission Tomography (%BC): 18.93] [Radiology (%BC): 18.93] [Laboratory (%BC): 50.30] [Occupational Therapy (%BC): 50.30] [Physical Therapy (%BC): 50.30] [Speech Therapy (%BC): 50.30] [Other Outpatient Implant (%BC): 24.52] [IV Therapy (%BC): 50.30] [All Other OP (%BC): 50.30]","count":"1 through 10","median_amount":1938.49,"10th_percentile":1938.49,"90th_percentile":1938.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":424.56,"10th_percentile":424.56,"90th_percentile":424.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 27.6] [Cardiac Cath (%BC): 27.6] [Observation (%BC): 42.8] [Emergency Department (%BC): 42.8] [Occupational Therapy (%BC): 27.6] [Physical Therapy (%BC): 27.6] [Respiratory Services/Therapy  (%BC): 27.6] [Speech Therapy (%BC): 27.6] [All Other OP (%BC): 27.6]","count":"31","median_amount":2677.4,"10th_percentile":2062.8,"90th_percentile":3894.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"First Health/Coventry","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"1 through 10","median_amount":681.27,"10th_percentile":681.27,"90th_percentile":681.27},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":96.93,"10th_percentile":96.93,"90th_percentile":113.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":421.38,"10th_percentile":421.38,"90th_percentile":421.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":780.49,"10th_percentile":780.49,"90th_percentile":780.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":204.79,"10th_percentile":115.31,"90th_percentile":332.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"21","median_amount":618.38,"10th_percentile":617.03,"90th_percentile":1532.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"17","median_amount":142.05,"10th_percentile":112.0,"90th_percentile":254.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 60.4] [Cardiac Cath (%BC): 60.4] [Observation (%BC): 53.7] [Emergency Department (%BC): 53.7] [Occupational Therapy (%BC): 60.4] [Physical Therapy (%BC): 60.4] [Respiratory Services/Therapy  (%BC): 60.4] [Speech Therapy (%BC): 60.4] [All Other OP (%BC): 60.4]","count":"1 through 10","median_amount":1781.76,"10th_percentile":933.03,"90th_percentile":2786.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":442.93,"10th_percentile":442.93,"90th_percentile":590.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 5 Type A ED Visits","code_information":[{"code":"5025","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 33.9] [Cardiac Cath (%BC): 33.9] [Observation (%BC): 57.7] [Emergency Department (%BC): 57.7] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 33.9] [Occupational Therapy (%BC): 33.9] [Physical Therapy (%BC): 33.9] [Respiratory Services/Therapy  (%BC): 33.9] [Speech Therapy (%BC): 33.9] [All Other OP (%BC): 33.9]","count":"13","median_amount":6606.86,"10th_percentile":1079.2,"90th_percentile":16200.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":740.94,"10th_percentile":740.94,"90th_percentile":816.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"15","median_amount":2714.62,"10th_percentile":629.74,"90th_percentile":3014.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Avmed","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Baycare Plus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 30.92] [Cardiac Cath (%BC): 30.92] [Lithotripsy (%BC): 30.92] [PTCA (%BC): 30.92] [Observation (%BC): 47.84] [Emergency Department (%BC): 47.84] [Other Cardiac Testing (%BC): 41.01] [EEG (%BC): 41.01] [Chemotherapy (%BC): 41.01] [Nuclear Medicine (%BC): 15.94] [Radiation Therapy  (%BC): 41.01] [CT OP Scan (%BC): 15.94] [MRI OP (%BC): 15.94] [Positron Emission Tomography (%BC): 15.94] [Radiology (%BC): 15.94] [Laboratory (%BC): 41.01] [Occupational Therapy (%BC): 41.01] [Physical Therapy (%BC): 41.01] [Speech Therapy (%BC): 41.01] [Other Outpatient Implant (%BC): 24.52] [IV Therapy (%BC): 41.01] [All Other OP (%BC): 41.01]","count":"14","median_amount":14774.88,"10th_percentile":6032.94,"90th_percentile":21053.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50] [All Other OP (%BC): 16.218]","count":"1 through 10","median_amount":2726.93,"10th_percentile":2726.93,"90th_percentile":2890.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 45.89] [Cardiac Cath (%BC): 45.89] [Lithotripsy (%BC): 45.89] [PTCA (%BC): 45.89] [Observation (%BC): 55.14] [Emergency Department (%BC): 55.14] [Other Cardiac Testing (%BC): 50.30] [EEG (%BC): 50.30] [Chemotherapy (%BC): 50.30] [Nuclear Medicine (%BC): 18.93] [Radiation Therapy  (%BC): 50.30] [CT OP Scan (%BC): 18.93] [MRI OP (%BC): 18.93] [Positron Emission Tomography (%BC): 18.93] [Radiology (%BC): 18.93] [Laboratory (%BC): 50.30] [Occupational Therapy (%BC): 50.30] [Physical Therapy (%BC): 50.30] [Speech Therapy (%BC): 50.30] [Other Outpatient Implant (%BC): 24.52] [IV Therapy (%BC): 50.30] [All Other OP (%BC): 50.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2752.33,"10th_percentile":2752.33,"90th_percentile":2752.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 27.6] [Cardiac Cath (%BC): 27.6] [Observation (%BC): 42.8] [Emergency Department (%BC): 42.8] [Occupational Therapy (%BC): 27.6] [Physical Therapy (%BC): 27.6] [Respiratory Services/Therapy  (%BC): 27.6] [Speech Therapy (%BC): 27.6] [All Other OP (%BC): 27.6]","count":"1 through 10","median_amount":4701.2,"10th_percentile":4509.24,"90th_percentile":16592.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"First Health/Coventry","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":715.0,"10th_percentile":333.02,"90th_percentile":916.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2616.14,"10th_percentile":2616.14,"90th_percentile":2636.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":5027.96,"10th_percentile":5027.96,"90th_percentile":5027.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":381.06,"10th_percentile":115.31,"90th_percentile":595.15,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"14","median_amount":5969.97,"10th_percentile":5900.18,"90th_percentile":6283.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":345.59,"10th_percentile":169.35,"90th_percentile":473.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 60.4] [Cardiac Cath (%BC): 60.4] [Observation (%BC): 53.7] [Emergency Department (%BC): 53.7] [Occupational Therapy (%BC): 60.4] [Physical Therapy (%BC): 60.4] [Respiratory Services/Therapy  (%BC): 60.4] [Speech Therapy (%BC): 60.4] [All Other OP (%BC): 60.4]","count":"1 through 10","median_amount":14684.04,"10th_percentile":4829.31,"90th_percentile":31889.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"17","median_amount":2754.84,"10th_percentile":2737.02,"90th_percentile":2926.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Critical Care","code_information":[{"code":"5041","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 33.9] [Cardiac Cath (%BC): 33.9] [Observation (%BC): 57.7] [Emergency Department (%BC): 57.7] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 33.9] [Occupational Therapy (%BC): 33.9] [Physical Therapy (%BC): 33.9] [Respiratory Services/Therapy  (%BC): 33.9] [Speech Therapy (%BC): 33.9] [All Other OP (%BC): 33.9]","count":"1 through 10","median_amount":21721.07,"10th_percentile":21721.07,"90th_percentile":21721.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2709.37,"10th_percentile":2709.37,"90th_percentile":2709.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Avmed","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Baycare Plus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 30.92] [Cardiac Cath (%BC): 30.92] [Lithotripsy (%BC): 30.92] [PTCA (%BC): 30.92] [Observation (%BC): 47.84] [Emergency Department (%BC): 47.84] [Other Cardiac Testing (%BC): 41.01] [EEG (%BC): 41.01] [Chemotherapy (%BC): 41.01] [Nuclear Medicine (%BC): 15.94] [Radiation Therapy  (%BC): 41.01] [CT OP Scan (%BC): 15.94] [MRI OP (%BC): 15.94] [Positron Emission Tomography (%BC): 15.94] [Radiology (%BC): 15.94] [Laboratory (%BC): 41.01] [Occupational Therapy (%BC): 41.01] [Physical Therapy (%BC): 41.01] [Speech Therapy (%BC): 41.01] [Other Outpatient Implant (%BC): 24.52] [IV Therapy (%BC): 41.01] [All Other OP (%BC): 41.01]","count":"1 through 10","median_amount":29492.27,"10th_percentile":29492.27,"90th_percentile":29492.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50] [All Other OP (%BC): 16.218]","count":"1 through 10","median_amount":2746.97,"10th_percentile":2746.97,"90th_percentile":2746.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 45.89] [Cardiac Cath (%BC): 45.89] [Lithotripsy (%BC): 45.89] [PTCA (%BC): 45.89] [Observation (%BC): 55.14] [Emergency Department (%BC): 55.14] [Other Cardiac Testing (%BC): 50.30] [EEG (%BC): 50.30] [Chemotherapy (%BC): 50.30] [Nuclear Medicine (%BC): 18.93] [Radiation Therapy  (%BC): 50.30] [CT OP Scan (%BC): 18.93] [MRI OP (%BC): 18.93] [Positron Emission Tomography (%BC): 18.93] [Radiology (%BC): 18.93] [Laboratory (%BC): 50.30] [Occupational Therapy (%BC): 50.30] [Physical Therapy (%BC): 50.30] [Speech Therapy (%BC): 50.30] [Other Outpatient Implant (%BC): 24.52] [IV Therapy (%BC): 50.30] [All Other OP (%BC): 50.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 27.6] [Cardiac Cath (%BC): 27.6] [Observation (%BC): 42.8] [Emergency Department (%BC): 42.8] [Occupational Therapy (%BC): 27.6] [Physical Therapy (%BC): 27.6] [Respiratory Services/Therapy  (%BC): 27.6] [Speech Therapy (%BC): 27.6] [All Other OP (%BC): 27.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":690.64,"10th_percentile":690.64,"90th_percentile":790.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":4881.74,"10th_percentile":4881.74,"90th_percentile":4881.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":782.66,"10th_percentile":782.66,"90th_percentile":782.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2789.44,"10th_percentile":2789.44,"90th_percentile":2789.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":5901.53,"10th_percentile":5900.18,"90th_percentile":5984.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":140.96,"10th_percentile":140.96,"90th_percentile":140.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 60.4] [Cardiac Cath (%BC): 60.4] [Observation (%BC): 53.7] [Emergency Department (%BC): 53.7] [Occupational Therapy (%BC): 60.4] [Physical Therapy (%BC): 60.4] [Respiratory Services/Therapy  (%BC): 60.4] [Speech Therapy (%BC): 60.4] [All Other OP (%BC): 60.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Skin Procedures","code_information":[{"code":"5051","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 33.9] [Cardiac Cath (%BC): 33.9] [Observation (%BC): 57.7] [Emergency Department (%BC): 57.7] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 33.9] [Occupational Therapy (%BC): 33.9] [Physical Therapy (%BC): 33.9] [Respiratory Services/Therapy  (%BC): 33.9] [Speech Therapy (%BC): 33.9] [All Other OP (%BC): 33.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Avmed","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Baycare Plus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 30.92] [Cardiac Cath (%BC): 30.92] [Lithotripsy (%BC): 30.92] [PTCA (%BC): 30.92] [Observation (%BC): 47.84] [Emergency Department (%BC): 47.84] [Other Cardiac Testing (%BC): 41.01] [EEG (%BC): 41.01] [Chemotherapy (%BC): 41.01] [Nuclear Medicine (%BC): 15.94] [Radiation Therapy  (%BC): 41.01] [CT OP Scan (%BC): 15.94] [MRI OP (%BC): 15.94] [Positron Emission Tomography (%BC): 15.94] [Radiology (%BC): 15.94] [Laboratory (%BC): 41.01] [Occupational Therapy (%BC): 41.01] [Physical Therapy (%BC): 41.01] [Speech Therapy (%BC): 41.01] [Other Outpatient Implant (%BC): 24.52] [IV Therapy (%BC): 41.01] [All Other OP (%BC): 41.01]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50] [All Other OP (%BC): 16.218]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 45.89] [Cardiac Cath (%BC): 45.89] [Lithotripsy (%BC): 45.89] [PTCA (%BC): 45.89] [Observation (%BC): 55.14] [Emergency Department (%BC): 55.14] [Other Cardiac Testing (%BC): 50.30] [EEG (%BC): 50.30] [Chemotherapy (%BC): 50.30] [Nuclear Medicine (%BC): 18.93] [Radiation Therapy  (%BC): 50.30] [CT OP Scan (%BC): 18.93] [MRI OP (%BC): 18.93] [Positron Emission Tomography (%BC): 18.93] [Radiology (%BC): 18.93] [Laboratory (%BC): 50.30] [Occupational Therapy (%BC): 50.30] [Physical Therapy (%BC): 50.30] [Speech Therapy (%BC): 50.30] [Other Outpatient Implant (%BC): 24.52] [IV Therapy (%BC): 50.30] [All Other OP (%BC): 50.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 27.6] [Cardiac Cath (%BC): 27.6] [Observation (%BC): 42.8] [Emergency Department (%BC): 42.8] [Occupational Therapy (%BC): 27.6] [Physical Therapy (%BC): 27.6] [Respiratory Services/Therapy  (%BC): 27.6] [Speech Therapy (%BC): 27.6] [All Other OP (%BC): 27.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":211.8,"10th_percentile":211.8,"90th_percentile":211.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1059.81,"10th_percentile":1059.81,"90th_percentile":1391.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 60.4] [Cardiac Cath (%BC): 60.4] [Observation (%BC): 53.7] [Emergency Department (%BC): 53.7] [Occupational Therapy (%BC): 60.4] [Physical Therapy (%BC): 60.4] [Respiratory Services/Therapy  (%BC): 60.4] [Speech Therapy (%BC): 60.4] [All Other OP (%BC): 60.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Skin Procedures","code_information":[{"code":"5052","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 33.9] [Cardiac Cath (%BC): 33.9] [Observation (%BC): 57.7] [Emergency Department (%BC): 57.7] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 33.9] [Occupational Therapy (%BC): 33.9] [Physical Therapy (%BC): 33.9] [Respiratory Services/Therapy  (%BC): 33.9] [Speech Therapy (%BC): 33.9] [All Other OP (%BC): 33.9]","count":"1 through 10","median_amount":1142.1,"10th_percentile":1142.1,"90th_percentile":1142.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":394.18,"10th_percentile":394.18,"90th_percentile":394.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Avmed","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Baycare Plus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 30.92] [Cardiac Cath (%BC): 30.92] [Lithotripsy (%BC): 30.92] [PTCA (%BC): 30.92] [Observation (%BC): 47.84] [Emergency Department (%BC): 47.84] [Other Cardiac Testing (%BC): 41.01] [EEG (%BC): 41.01] [Chemotherapy (%BC): 41.01] [Nuclear Medicine (%BC): 15.94] [Radiation Therapy  (%BC): 41.01] [CT OP Scan (%BC): 15.94] [MRI OP (%BC): 15.94] [Positron Emission Tomography (%BC): 15.94] [Radiology (%BC): 15.94] [Laboratory (%BC): 41.01] [Occupational Therapy (%BC): 41.01] [Physical Therapy (%BC): 41.01] [Speech Therapy (%BC): 41.01] [Other Outpatient Implant (%BC): 24.52] [IV Therapy (%BC): 41.01] [All Other OP (%BC): 41.01]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50] [All Other OP (%BC): 16.218]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 45.89] [Cardiac Cath (%BC): 45.89] [Lithotripsy (%BC): 45.89] [PTCA (%BC): 45.89] [Observation (%BC): 55.14] [Emergency Department (%BC): 55.14] [Other Cardiac Testing (%BC): 50.30] [EEG (%BC): 50.30] [Chemotherapy (%BC): 50.30] [Nuclear Medicine (%BC): 18.93] [Radiation Therapy  (%BC): 50.30] [CT OP Scan (%BC): 18.93] [MRI OP (%BC): 18.93] [Positron Emission Tomography (%BC): 18.93] [Radiology (%BC): 18.93] [Laboratory (%BC): 50.30] [Occupational Therapy (%BC): 50.30] [Physical Therapy (%BC): 50.30] [Speech Therapy (%BC): 50.30] [Other Outpatient Implant (%BC): 24.52] [IV Therapy (%BC): 50.30] [All Other OP (%BC): 50.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 27.6] [Cardiac Cath (%BC): 27.6] [Observation (%BC): 42.8] [Emergency Department (%BC): 42.8] [Occupational Therapy (%BC): 27.6] [Physical Therapy (%BC): 27.6] [Respiratory Services/Therapy  (%BC): 27.6] [Speech Therapy (%BC): 27.6] [All Other OP (%BC): 27.6]","count":"1 through 10","median_amount":3367.77,"10th_percentile":3367.77,"90th_percentile":3367.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"First Health/Coventry","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":245.85,"10th_percentile":245.85,"90th_percentile":245.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":398.22,"10th_percentile":398.22,"90th_percentile":398.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":108.76,"10th_percentile":108.76,"90th_percentile":108.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1243.2,"10th_percentile":1243.2,"90th_percentile":1243.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":250.62,"10th_percentile":250.62,"90th_percentile":250.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 60.4] [Cardiac Cath (%BC): 60.4] [Observation (%BC): 53.7] [Emergency Department (%BC): 53.7] [Occupational Therapy (%BC): 60.4] [Physical Therapy (%BC): 60.4] [Respiratory Services/Therapy  (%BC): 60.4] [Speech Therapy (%BC): 60.4] [All Other OP (%BC): 60.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 3 Skin Procedures","code_information":[{"code":"5053","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 33.9] [Cardiac Cath (%BC): 33.9] [Observation (%BC): 57.7] [Emergency Department (%BC): 57.7] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 33.9] [Occupational Therapy (%BC): 33.9] [Physical Therapy (%BC): 33.9] [Respiratory Services/Therapy  (%BC): 33.9] [Speech Therapy (%BC): 33.9] [All Other OP (%BC): 33.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Avmed","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Baycare Plus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 30.92] [Cardiac Cath (%BC): 30.92] [Lithotripsy (%BC): 30.92] [PTCA (%BC): 30.92] [Observation (%BC): 47.84] [Emergency Department (%BC): 47.84] [Other Cardiac Testing (%BC): 41.01] [EEG (%BC): 41.01] [Chemotherapy (%BC): 41.01] [Nuclear Medicine (%BC): 15.94] [Radiation Therapy  (%BC): 41.01] [CT OP Scan (%BC): 15.94] [MRI OP (%BC): 15.94] [Positron Emission Tomography (%BC): 15.94] [Radiology (%BC): 15.94] [Laboratory (%BC): 41.01] [Occupational Therapy (%BC): 41.01] [Physical Therapy (%BC): 41.01] [Speech Therapy (%BC): 41.01] [Other Outpatient Implant (%BC): 24.52] [IV Therapy (%BC): 41.01] [All Other OP (%BC): 41.01]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50] [All Other OP (%BC): 16.218]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 45.89] [Cardiac Cath (%BC): 45.89] [Lithotripsy (%BC): 45.89] [PTCA (%BC): 45.89] [Observation (%BC): 55.14] [Emergency Department (%BC): 55.14] [Other Cardiac Testing (%BC): 50.30] [EEG (%BC): 50.30] [Chemotherapy (%BC): 50.30] [Nuclear Medicine (%BC): 18.93] [Radiation Therapy  (%BC): 50.30] [CT OP Scan (%BC): 18.93] [MRI OP (%BC): 18.93] [Positron Emission Tomography (%BC): 18.93] [Radiology (%BC): 18.93] [Laboratory (%BC): 50.30] [Occupational Therapy (%BC): 50.30] [Physical Therapy (%BC): 50.30] [Speech Therapy (%BC): 50.30] [Other Outpatient Implant (%BC): 24.52] [IV Therapy (%BC): 50.30] [All Other OP (%BC): 50.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 27.6] [Cardiac Cath (%BC): 27.6] [Observation (%BC): 42.8] [Emergency Department (%BC): 42.8] [Occupational Therapy (%BC): 27.6] [Physical Therapy (%BC): 27.6] [Respiratory Services/Therapy  (%BC): 27.6] [Speech Therapy (%BC): 27.6] [All Other OP (%BC): 27.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":384.69,"10th_percentile":384.69,"90th_percentile":384.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 60.4] [Cardiac Cath (%BC): 60.4] [Observation (%BC): 53.7] [Emergency Department (%BC): 53.7] [Occupational Therapy (%BC): 60.4] [Physical Therapy (%BC): 60.4] [Respiratory Services/Therapy  (%BC): 60.4] [Speech Therapy (%BC): 60.4] [All Other OP (%BC): 60.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Excision/ Biopsy/ Incision and Drainage","code_information":[{"code":"5071","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 33.9] [Cardiac Cath (%BC): 33.9] [Observation (%BC): 57.7] [Emergency Department (%BC): 57.7] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 33.9] [Occupational Therapy (%BC): 33.9] [Physical Therapy (%BC): 33.9] [Respiratory Services/Therapy  (%BC): 33.9] [Speech Therapy (%BC): 33.9] [All Other OP (%BC): 33.9]","count":"1 through 10","median_amount":7624.55,"10th_percentile":7624.55,"90th_percentile":7624.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Avmed","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Baycare Plus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 30.92] [Cardiac Cath (%BC): 30.92] [Lithotripsy (%BC): 30.92] [PTCA (%BC): 30.92] [Observation (%BC): 47.84] [Emergency Department (%BC): 47.84] [Other Cardiac Testing (%BC): 41.01] [EEG (%BC): 41.01] [Chemotherapy (%BC): 41.01] [Nuclear Medicine (%BC): 15.94] [Radiation Therapy  (%BC): 41.01] [CT OP Scan (%BC): 15.94] [MRI OP (%BC): 15.94] [Positron Emission Tomography (%BC): 15.94] [Radiology (%BC): 15.94] [Laboratory (%BC): 41.01] [Occupational Therapy (%BC): 41.01] [Physical Therapy (%BC): 41.01] [Speech Therapy (%BC): 41.01] [Other Outpatient Implant (%BC): 24.52] [IV Therapy (%BC): 41.01] [All Other OP (%BC): 41.01]","count":"1 through 10","median_amount":2869.86,"10th_percentile":2869.86,"90th_percentile":4803.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50] [All Other OP (%BC): 16.218]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 45.89] [Cardiac Cath (%BC): 45.89] [Lithotripsy (%BC): 45.89] [PTCA (%BC): 45.89] [Observation (%BC): 55.14] [Emergency Department (%BC): 55.14] [Other Cardiac Testing (%BC): 50.30] [EEG (%BC): 50.30] [Chemotherapy (%BC): 50.30] [Nuclear Medicine (%BC): 18.93] [Radiation Therapy  (%BC): 50.30] [CT OP Scan (%BC): 18.93] [MRI OP (%BC): 18.93] [Positron Emission Tomography (%BC): 18.93] [Radiology (%BC): 18.93] [Laboratory (%BC): 50.30] [Occupational Therapy (%BC): 50.30] [Physical Therapy (%BC): 50.30] [Speech Therapy (%BC): 50.30] [Other Outpatient Implant (%BC): 24.52] [IV Therapy (%BC): 50.30] [All Other OP (%BC): 50.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":718.64,"10th_percentile":718.64,"90th_percentile":718.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 27.6] [Cardiac Cath (%BC): 27.6] [Observation (%BC): 42.8] [Emergency Department (%BC): 42.8] [Occupational Therapy (%BC): 27.6] [Physical Therapy (%BC): 27.6] [Respiratory Services/Therapy  (%BC): 27.6] [Speech Therapy (%BC): 27.6] [All Other OP (%BC): 27.6]","count":"1 through 10","median_amount":2227.91,"10th_percentile":2227.91,"90th_percentile":2227.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"First Health/Coventry","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":698.02,"10th_percentile":698.02,"90th_percentile":698.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1567.88,"10th_percentile":1567.88,"90th_percentile":1567.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 60.4] [Cardiac Cath (%BC): 60.4] [Observation (%BC): 53.7] [Emergency Department (%BC): 53.7] [Occupational Therapy (%BC): 60.4] [Physical Therapy (%BC): 60.4] [Respiratory Services/Therapy  (%BC): 60.4] [Speech Therapy (%BC): 60.4] [All Other OP (%BC): 60.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":729.69,"10th_percentile":729.69,"90th_percentile":729.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Excision/ Biopsy/ Incision and Drainage","code_information":[{"code":"5072","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 33.9] [Cardiac Cath (%BC): 33.9] [Observation (%BC): 57.7] [Emergency Department (%BC): 57.7] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 33.9] [Occupational Therapy (%BC): 33.9] [Physical Therapy (%BC): 33.9] [Respiratory Services/Therapy  (%BC): 33.9] [Speech Therapy (%BC): 33.9] [All Other OP (%BC): 33.9]","count":"1 through 10","median_amount":11816.97,"10th_percentile":11816.97,"90th_percentile":11816.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Avmed","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Baycare Plus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 30.92] [Cardiac Cath (%BC): 30.92] [Lithotripsy (%BC): 30.92] [PTCA (%BC): 30.92] [Observation (%BC): 47.84] [Emergency Department (%BC): 47.84] [Other Cardiac Testing (%BC): 41.01] [EEG (%BC): 41.01] [Chemotherapy (%BC): 41.01] [Nuclear Medicine (%BC): 15.94] [Radiation Therapy  (%BC): 41.01] [CT OP Scan (%BC): 15.94] [MRI OP (%BC): 15.94] [Positron Emission Tomography (%BC): 15.94] [Radiology (%BC): 15.94] [Laboratory (%BC): 41.01] [Occupational Therapy (%BC): 41.01] [Physical Therapy (%BC): 41.01] [Speech Therapy (%BC): 41.01] [Other Outpatient Implant (%BC): 24.52] [IV Therapy (%BC): 41.01] [All Other OP (%BC): 41.01]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50] [All Other OP (%BC): 16.218]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 45.89] [Cardiac Cath (%BC): 45.89] [Lithotripsy (%BC): 45.89] [PTCA (%BC): 45.89] [Observation (%BC): 55.14] [Emergency Department (%BC): 55.14] [Other Cardiac Testing (%BC): 50.30] [EEG (%BC): 50.30] [Chemotherapy (%BC): 50.30] [Nuclear Medicine (%BC): 18.93] [Radiation Therapy  (%BC): 50.30] [CT OP Scan (%BC): 18.93] [MRI OP (%BC): 18.93] [Positron Emission Tomography (%BC): 18.93] [Radiology (%BC): 18.93] [Laboratory (%BC): 50.30] [Occupational Therapy (%BC): 50.30] [Physical Therapy (%BC): 50.30] [Speech Therapy (%BC): 50.30] [Other Outpatient Implant (%BC): 24.52] [IV Therapy (%BC): 50.30] [All Other OP (%BC): 50.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 27.6] [Cardiac Cath (%BC): 27.6] [Observation (%BC): 42.8] [Emergency Department (%BC): 42.8] [Occupational Therapy (%BC): 27.6] [Physical Therapy (%BC): 27.6] [Respiratory Services/Therapy  (%BC): 27.6] [Speech Therapy (%BC): 27.6] [All Other OP (%BC): 27.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1610.1,"10th_percentile":1610.1,"90th_percentile":1610.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":1371.68,"10th_percentile":1371.68,"90th_percentile":1371.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 60.4] [Cardiac Cath (%BC): 60.4] [Observation (%BC): 53.7] [Emergency Department (%BC): 53.7] [Occupational Therapy (%BC): 60.4] [Physical Therapy (%BC): 60.4] [Respiratory Services/Therapy  (%BC): 60.4] [Speech Therapy (%BC): 60.4] [All Other OP (%BC): 60.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 3 Excision/ Biopsy/ Incision and Drainage","code_information":[{"code":"5073","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 33.9] [Cardiac Cath (%BC): 33.9] [Observation (%BC): 57.7] [Emergency Department (%BC): 57.7] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 33.9] [Occupational Therapy (%BC): 33.9] [Physical Therapy (%BC): 33.9] [Respiratory Services/Therapy  (%BC): 33.9] [Speech Therapy (%BC): 33.9] [All Other OP (%BC): 33.9]","count":"1 through 10","median_amount":48573.81,"10th_percentile":48573.81,"90th_percentile":48573.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2933.82,"10th_percentile":2933.82,"90th_percentile":2933.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Avmed","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Baycare Plus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 30.92] [Cardiac Cath (%BC): 30.92] [Lithotripsy (%BC): 30.92] [PTCA (%BC): 30.92] [Observation (%BC): 47.84] [Emergency Department (%BC): 47.84] [Other Cardiac Testing (%BC): 41.01] [EEG (%BC): 41.01] [Chemotherapy (%BC): 41.01] [Nuclear Medicine (%BC): 15.94] [Radiation Therapy  (%BC): 41.01] [CT OP Scan (%BC): 15.94] [MRI OP (%BC): 15.94] [Positron Emission Tomography (%BC): 15.94] [Radiology (%BC): 15.94] [Laboratory (%BC): 41.01] [Occupational Therapy (%BC): 41.01] [Physical Therapy (%BC): 41.01] [Speech Therapy (%BC): 41.01] [Other Outpatient Implant (%BC): 24.52] [IV Therapy (%BC): 41.01] [All Other OP (%BC): 41.01]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50] [All Other OP (%BC): 16.218]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 45.89] [Cardiac Cath (%BC): 45.89] [Lithotripsy (%BC): 45.89] [PTCA (%BC): 45.89] [Observation (%BC): 55.14] [Emergency Department (%BC): 55.14] [Other Cardiac Testing (%BC): 50.30] [EEG (%BC): 50.30] [Chemotherapy (%BC): 50.30] [Nuclear Medicine (%BC): 18.93] [Radiation Therapy  (%BC): 50.30] [CT OP Scan (%BC): 18.93] [MRI OP (%BC): 18.93] [Positron Emission Tomography (%BC): 18.93] [Radiology (%BC): 18.93] [Laboratory (%BC): 50.30] [Occupational Therapy (%BC): 50.30] [Physical Therapy (%BC): 50.30] [Speech Therapy (%BC): 50.30] [Other Outpatient Implant (%BC): 24.52] [IV Therapy (%BC): 50.30] [All Other OP (%BC): 50.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 27.6] [Cardiac Cath (%BC): 27.6] [Observation (%BC): 42.8] [Emergency Department (%BC): 42.8] [Occupational Therapy (%BC): 27.6] [Physical Therapy (%BC): 27.6] [Respiratory Services/Therapy  (%BC): 27.6] [Speech Therapy (%BC): 27.6] [All Other OP (%BC): 27.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":1230.86,"10th_percentile":1230.86,"90th_percentile":1230.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 60.4] [Cardiac Cath (%BC): 60.4] [Observation (%BC): 53.7] [Emergency Department (%BC): 53.7] [Occupational Therapy (%BC): 60.4] [Physical Therapy (%BC): 60.4] [Respiratory Services/Therapy  (%BC): 60.4] [Speech Therapy (%BC): 60.4] [All Other OP (%BC): 60.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2977.13,"10th_percentile":2977.13,"90th_percentile":2977.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Breast/Lymphatic Surgery and Related Procedures","code_information":[{"code":"5091","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 33.9] [Cardiac Cath (%BC): 33.9] [Observation (%BC): 57.7] [Emergency Department (%BC): 57.7] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 33.9] [Occupational Therapy (%BC): 33.9] [Physical Therapy (%BC): 33.9] [Respiratory Services/Therapy  (%BC): 33.9] [Speech Therapy (%BC): 33.9] [All Other OP (%BC): 33.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Avmed","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Baycare Plus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 30.92] [Cardiac Cath (%BC): 30.92] [Lithotripsy (%BC): 30.92] [PTCA (%BC): 30.92] [Observation (%BC): 47.84] [Emergency Department (%BC): 47.84] [Other Cardiac Testing (%BC): 41.01] [EEG (%BC): 41.01] [Chemotherapy (%BC): 41.01] [Nuclear Medicine (%BC): 15.94] [Radiation Therapy  (%BC): 41.01] [CT OP Scan (%BC): 15.94] [MRI OP (%BC): 15.94] [Positron Emission Tomography (%BC): 15.94] [Radiology (%BC): 15.94] [Laboratory (%BC): 41.01] [Occupational Therapy (%BC): 41.01] [Physical Therapy (%BC): 41.01] [Speech Therapy (%BC): 41.01] [Other Outpatient Implant (%BC): 24.52] [IV Therapy (%BC): 41.01] [All Other OP (%BC): 41.01]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50] [All Other OP (%BC): 16.218]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 45.89] [Cardiac Cath (%BC): 45.89] [Lithotripsy (%BC): 45.89] [PTCA (%BC): 45.89] [Observation (%BC): 55.14] [Emergency Department (%BC): 55.14] [Other Cardiac Testing (%BC): 50.30] [EEG (%BC): 50.30] [Chemotherapy (%BC): 50.30] [Nuclear Medicine (%BC): 18.93] [Radiation Therapy  (%BC): 50.30] [CT OP Scan (%BC): 18.93] [MRI OP (%BC): 18.93] [Positron Emission Tomography (%BC): 18.93] [Radiology (%BC): 18.93] [Laboratory (%BC): 50.30] [Occupational Therapy (%BC): 50.30] [Physical Therapy (%BC): 50.30] [Speech Therapy (%BC): 50.30] [Other Outpatient Implant (%BC): 24.52] [IV Therapy (%BC): 50.30] [All Other OP (%BC): 50.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 27.6] [Cardiac Cath (%BC): 27.6] [Observation (%BC): 42.8] [Emergency Department (%BC): 42.8] [Occupational Therapy (%BC): 27.6] [Physical Therapy (%BC): 27.6] [Respiratory Services/Therapy  (%BC): 27.6] [Speech Therapy (%BC): 27.6] [All Other OP (%BC): 27.6]","count":"1 through 10","median_amount":38949.65,"10th_percentile":38949.65,"90th_percentile":38949.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"First Health/Coventry","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 60.4] [Cardiac Cath (%BC): 60.4] [Observation (%BC): 53.7] [Emergency Department (%BC): 53.7] [Occupational Therapy (%BC): 60.4] [Physical Therapy (%BC): 60.4] [Respiratory Services/Therapy  (%BC): 60.4] [Speech Therapy (%BC): 60.4] [All Other OP (%BC): 60.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Strapping and Cast Application","code_information":[{"code":"5101","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 33.9] [Cardiac Cath (%BC): 33.9] [Observation (%BC): 57.7] [Emergency Department (%BC): 57.7] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 33.9] [Occupational Therapy (%BC): 33.9] [Physical Therapy (%BC): 33.9] [Respiratory Services/Therapy  (%BC): 33.9] [Speech Therapy (%BC): 33.9] [All Other OP (%BC): 33.9]","count":"1 through 10","median_amount":3664.99,"10th_percentile":3664.99,"90th_percentile":3664.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Avmed","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Baycare Plus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 30.92] [Cardiac Cath (%BC): 30.92] [Lithotripsy (%BC): 30.92] [PTCA (%BC): 30.92] [Observation (%BC): 47.84] [Emergency Department (%BC): 47.84] [Other Cardiac Testing (%BC): 41.01] [EEG (%BC): 41.01] [Chemotherapy (%BC): 41.01] [Nuclear Medicine (%BC): 15.94] [Radiation Therapy  (%BC): 41.01] [CT OP Scan (%BC): 15.94] [MRI OP (%BC): 15.94] [Positron Emission Tomography (%BC): 15.94] [Radiology (%BC): 15.94] [Laboratory (%BC): 41.01] [Occupational Therapy (%BC): 41.01] [Physical Therapy (%BC): 41.01] [Speech Therapy (%BC): 41.01] [Other Outpatient Implant (%BC): 24.52] [IV Therapy (%BC): 41.01] [All Other OP (%BC): 41.01]","count":"1 through 10","median_amount":1138.11,"10th_percentile":1138.11,"90th_percentile":1138.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50] [All Other OP (%BC): 16.218]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 45.89] [Cardiac Cath (%BC): 45.89] [Lithotripsy (%BC): 45.89] [PTCA (%BC): 45.89] [Observation (%BC): 55.14] [Emergency Department (%BC): 55.14] [Other Cardiac Testing (%BC): 50.30] [EEG (%BC): 50.30] [Chemotherapy (%BC): 50.30] [Nuclear Medicine (%BC): 18.93] [Radiation Therapy  (%BC): 50.30] [CT OP Scan (%BC): 18.93] [MRI OP (%BC): 18.93] [Positron Emission Tomography (%BC): 18.93] [Radiology (%BC): 18.93] [Laboratory (%BC): 50.30] [Occupational Therapy (%BC): 50.30] [Physical Therapy (%BC): 50.30] [Speech Therapy (%BC): 50.30] [Other Outpatient Implant (%BC): 24.52] [IV Therapy (%BC): 50.30] [All Other OP (%BC): 50.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 27.6] [Cardiac Cath (%BC): 27.6] [Observation (%BC): 42.8] [Emergency Department (%BC): 42.8] [Occupational Therapy (%BC): 27.6] [Physical Therapy (%BC): 27.6] [Respiratory Services/Therapy  (%BC): 27.6] [Speech Therapy (%BC): 27.6] [All Other OP (%BC): 27.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":187.68,"10th_percentile":187.68,"90th_percentile":187.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":191.32,"10th_percentile":191.32,"90th_percentile":191.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 60.4] [Cardiac Cath (%BC): 60.4] [Observation (%BC): 53.7] [Emergency Department (%BC): 53.7] [Occupational Therapy (%BC): 60.4] [Physical Therapy (%BC): 60.4] [Respiratory Services/Therapy  (%BC): 60.4] [Speech Therapy (%BC): 60.4] [All Other OP (%BC): 60.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Musculoskeletal Procedures","code_information":[{"code":"5111","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 33.9] [Cardiac Cath (%BC): 33.9] [Observation (%BC): 57.7] [Emergency Department (%BC): 57.7] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 33.9] [Occupational Therapy (%BC): 33.9] [Physical Therapy (%BC): 33.9] [Respiratory Services/Therapy  (%BC): 33.9] [Speech Therapy (%BC): 33.9] [All Other OP (%BC): 33.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":515.17,"10th_percentile":515.17,"90th_percentile":515.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Avmed","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Baycare Plus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 30.92] [Cardiac Cath (%BC): 30.92] [Lithotripsy (%BC): 30.92] [PTCA (%BC): 30.92] [Observation (%BC): 47.84] [Emergency Department (%BC): 47.84] [Other Cardiac Testing (%BC): 41.01] [EEG (%BC): 41.01] [Chemotherapy (%BC): 41.01] [Nuclear Medicine (%BC): 15.94] [Radiation Therapy  (%BC): 41.01] [CT OP Scan (%BC): 15.94] [MRI OP (%BC): 15.94] [Positron Emission Tomography (%BC): 15.94] [Radiology (%BC): 15.94] [Laboratory (%BC): 41.01] [Occupational Therapy (%BC): 41.01] [Physical Therapy (%BC): 41.01] [Speech Therapy (%BC): 41.01] [Other Outpatient Implant (%BC): 24.52] [IV Therapy (%BC): 41.01] [All Other OP (%BC): 41.01]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50] [All Other OP (%BC): 16.218]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 45.89] [Cardiac Cath (%BC): 45.89] [Lithotripsy (%BC): 45.89] [PTCA (%BC): 45.89] [Observation (%BC): 55.14] [Emergency Department (%BC): 55.14] [Other Cardiac Testing (%BC): 50.30] [EEG (%BC): 50.30] [Chemotherapy (%BC): 50.30] [Nuclear Medicine (%BC): 18.93] [Radiation Therapy  (%BC): 50.30] [CT OP Scan (%BC): 18.93] [MRI OP (%BC): 18.93] [Positron Emission Tomography (%BC): 18.93] [Radiology (%BC): 18.93] [Laboratory (%BC): 50.30] [Occupational Therapy (%BC): 50.30] [Physical Therapy (%BC): 50.30] [Speech Therapy (%BC): 50.30] [Other Outpatient Implant (%BC): 24.52] [IV Therapy (%BC): 50.30] [All Other OP (%BC): 50.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 27.6] [Cardiac Cath (%BC): 27.6] [Observation (%BC): 42.8] [Emergency Department (%BC): 42.8] [Occupational Therapy (%BC): 27.6] [Physical Therapy (%BC): 27.6] [Respiratory Services/Therapy  (%BC): 27.6] [Speech Therapy (%BC): 27.6] [All Other OP (%BC): 27.6]","count":"1 through 10","median_amount":6707.17,"10th_percentile":6707.17,"90th_percentile":6707.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"First Health/Coventry","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 60.4] [Cardiac Cath (%BC): 60.4] [Observation (%BC): 53.7] [Emergency Department (%BC): 53.7] [Occupational Therapy (%BC): 60.4] [Physical Therapy (%BC): 60.4] [Respiratory Services/Therapy  (%BC): 60.4] [Speech Therapy (%BC): 60.4] [All Other OP (%BC): 60.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Musculoskeletal Procedures","code_information":[{"code":"5112","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 33.9] [Cardiac Cath (%BC): 33.9] [Observation (%BC): 57.7] [Emergency Department (%BC): 57.7] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 33.9] [Occupational Therapy (%BC): 33.9] [Physical Therapy (%BC): 33.9] [Respiratory Services/Therapy  (%BC): 33.9] [Speech Therapy (%BC): 33.9] [All Other OP (%BC): 33.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Avmed","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Baycare Plus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 30.92] [Cardiac Cath (%BC): 30.92] [Lithotripsy (%BC): 30.92] [PTCA (%BC): 30.92] [Observation (%BC): 47.84] [Emergency Department (%BC): 47.84] [Other Cardiac Testing (%BC): 41.01] [EEG (%BC): 41.01] [Chemotherapy (%BC): 41.01] [Nuclear Medicine (%BC): 15.94] [Radiation Therapy  (%BC): 41.01] [CT OP Scan (%BC): 15.94] [MRI OP (%BC): 15.94] [Positron Emission Tomography (%BC): 15.94] [Radiology (%BC): 15.94] [Laboratory (%BC): 41.01] [Occupational Therapy (%BC): 41.01] [Physical Therapy (%BC): 41.01] [Speech Therapy (%BC): 41.01] [Other Outpatient Implant (%BC): 24.52] [IV Therapy (%BC): 41.01] [All Other OP (%BC): 41.01]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50] [All Other OP (%BC): 16.218]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 45.89] [Cardiac Cath (%BC): 45.89] [Lithotripsy (%BC): 45.89] [PTCA (%BC): 45.89] [Observation (%BC): 55.14] [Emergency Department (%BC): 55.14] [Other Cardiac Testing (%BC): 50.30] [EEG (%BC): 50.30] [Chemotherapy (%BC): 50.30] [Nuclear Medicine (%BC): 18.93] [Radiation Therapy  (%BC): 50.30] [CT OP Scan (%BC): 18.93] [MRI OP (%BC): 18.93] [Positron Emission Tomography (%BC): 18.93] [Radiology (%BC): 18.93] [Laboratory (%BC): 50.30] [Occupational Therapy (%BC): 50.30] [Physical Therapy (%BC): 50.30] [Speech Therapy (%BC): 50.30] [Other Outpatient Implant (%BC): 24.52] [IV Therapy (%BC): 50.30] [All Other OP (%BC): 50.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 27.6] [Cardiac Cath (%BC): 27.6] [Observation (%BC): 42.8] [Emergency Department (%BC): 42.8] [Occupational Therapy (%BC): 27.6] [Physical Therapy (%BC): 27.6] [Respiratory Services/Therapy  (%BC): 27.6] [Speech Therapy (%BC): 27.6] [All Other OP (%BC): 27.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":523.83,"10th_percentile":523.83,"90th_percentile":523.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3566.34,"10th_percentile":3566.34,"90th_percentile":3566.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 60.4] [Cardiac Cath (%BC): 60.4] [Observation (%BC): 53.7] [Emergency Department (%BC): 53.7] [Occupational Therapy (%BC): 60.4] [Physical Therapy (%BC): 60.4] [Respiratory Services/Therapy  (%BC): 60.4] [Speech Therapy (%BC): 60.4] [All Other OP (%BC): 60.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1507.04,"10th_percentile":1507.04,"90th_percentile":1507.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 3 Musculoskeletal Procedures","code_information":[{"code":"5113","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 33.9] [Cardiac Cath (%BC): 33.9] [Observation (%BC): 57.7] [Emergency Department (%BC): 57.7] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 33.9] [Occupational Therapy (%BC): 33.9] [Physical Therapy (%BC): 33.9] [Respiratory Services/Therapy  (%BC): 33.9] [Speech Therapy (%BC): 33.9] [All Other OP (%BC): 33.9]","count":"1 through 10","median_amount":15504.37,"10th_percentile":15504.37,"90th_percentile":15504.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Avmed","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Baycare Plus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 30.92] [Cardiac Cath (%BC): 30.92] [Lithotripsy (%BC): 30.92] [PTCA (%BC): 30.92] [Observation (%BC): 47.84] [Emergency Department (%BC): 47.84] [Other Cardiac Testing (%BC): 41.01] [EEG (%BC): 41.01] [Chemotherapy (%BC): 41.01] [Nuclear Medicine (%BC): 15.94] [Radiation Therapy  (%BC): 41.01] [CT OP Scan (%BC): 15.94] [MRI OP (%BC): 15.94] [Positron Emission Tomography (%BC): 15.94] [Radiology (%BC): 15.94] [Laboratory (%BC): 41.01] [Occupational Therapy (%BC): 41.01] [Physical Therapy (%BC): 41.01] [Speech Therapy (%BC): 41.01] [Other Outpatient Implant (%BC): 24.52] [IV Therapy (%BC): 41.01] [All Other OP (%BC): 41.01]","count":"1 through 10","median_amount":24895.89,"10th_percentile":24370.35,"90th_percentile":28460.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50] [All Other OP (%BC): 16.218]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 45.89] [Cardiac Cath (%BC): 45.89] [Lithotripsy (%BC): 45.89] [PTCA (%BC): 45.89] [Observation (%BC): 55.14] [Emergency Department (%BC): 55.14] [Other Cardiac Testing (%BC): 50.30] [EEG (%BC): 50.30] [Chemotherapy (%BC): 50.30] [Nuclear Medicine (%BC): 18.93] [Radiation Therapy  (%BC): 50.30] [CT OP Scan (%BC): 18.93] [MRI OP (%BC): 18.93] [Positron Emission Tomography (%BC): 18.93] [Radiology (%BC): 18.93] [Laboratory (%BC): 50.30] [Occupational Therapy (%BC): 50.30] [Physical Therapy (%BC): 50.30] [Speech Therapy (%BC): 50.30] [Other Outpatient Implant (%BC): 24.52] [IV Therapy (%BC): 50.30] [All Other OP (%BC): 50.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 27.6] [Cardiac Cath (%BC): 27.6] [Observation (%BC): 42.8] [Emergency Department (%BC): 42.8] [Occupational Therapy (%BC): 27.6] [Physical Therapy (%BC): 27.6] [Respiratory Services/Therapy  (%BC): 27.6] [Speech Therapy (%BC): 27.6] [All Other OP (%BC): 27.6]","count":"1 through 10","median_amount":32489.83,"10th_percentile":32489.83,"90th_percentile":32489.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"First Health/Coventry","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":7230.25,"10th_percentile":7230.25,"90th_percentile":7230.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 60.4] [Cardiac Cath (%BC): 60.4] [Observation (%BC): 53.7] [Emergency Department (%BC): 53.7] [Occupational Therapy (%BC): 60.4] [Physical Therapy (%BC): 60.4] [Respiratory Services/Therapy  (%BC): 60.4] [Speech Therapy (%BC): 60.4] [All Other OP (%BC): 60.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3360.21,"10th_percentile":3360.21,"90th_percentile":3360.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 4 Musculoskeletal Procedures","code_information":[{"code":"5114","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 33.9] [Cardiac Cath (%BC): 33.9] [Observation (%BC): 57.7] [Emergency Department (%BC): 57.7] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 33.9] [Occupational Therapy (%BC): 33.9] [Physical Therapy (%BC): 33.9] [Respiratory Services/Therapy  (%BC): 33.9] [Speech Therapy (%BC): 33.9] [All Other OP (%BC): 33.9]","count":"1 through 10","median_amount":23423.79,"10th_percentile":23423.79,"90th_percentile":23423.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Avmed","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Baycare Plus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 30.92] [Cardiac Cath (%BC): 30.92] [Lithotripsy (%BC): 30.92] [PTCA (%BC): 30.92] [Observation (%BC): 47.84] [Emergency Department (%BC): 47.84] [Other Cardiac Testing (%BC): 41.01] [EEG (%BC): 41.01] [Chemotherapy (%BC): 41.01] [Nuclear Medicine (%BC): 15.94] [Radiation Therapy  (%BC): 41.01] [CT OP Scan (%BC): 15.94] [MRI OP (%BC): 15.94] [Positron Emission Tomography (%BC): 15.94] [Radiology (%BC): 15.94] [Laboratory (%BC): 41.01] [Occupational Therapy (%BC): 41.01] [Physical Therapy (%BC): 41.01] [Speech Therapy (%BC): 41.01] [Other Outpatient Implant (%BC): 24.52] [IV Therapy (%BC): 41.01] [All Other OP (%BC): 41.01]","count":"1 through 10","median_amount":43109.93,"10th_percentile":43109.93,"90th_percentile":43109.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50] [All Other OP (%BC): 16.218]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 45.89] [Cardiac Cath (%BC): 45.89] [Lithotripsy (%BC): 45.89] [PTCA (%BC): 45.89] [Observation (%BC): 55.14] [Emergency Department (%BC): 55.14] [Other Cardiac Testing (%BC): 50.30] [EEG (%BC): 50.30] [Chemotherapy (%BC): 50.30] [Nuclear Medicine (%BC): 18.93] [Radiation Therapy  (%BC): 50.30] [CT OP Scan (%BC): 18.93] [MRI OP (%BC): 18.93] [Positron Emission Tomography (%BC): 18.93] [Radiology (%BC): 18.93] [Laboratory (%BC): 50.30] [Occupational Therapy (%BC): 50.30] [Physical Therapy (%BC): 50.30] [Speech Therapy (%BC): 50.30] [Other Outpatient Implant (%BC): 24.52] [IV Therapy (%BC): 50.30] [All Other OP (%BC): 50.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 27.6] [Cardiac Cath (%BC): 27.6] [Observation (%BC): 42.8] [Emergency Department (%BC): 42.8] [Occupational Therapy (%BC): 27.6] [Physical Therapy (%BC): 27.6] [Respiratory Services/Therapy  (%BC): 27.6] [Speech Therapy (%BC): 27.6] [All Other OP (%BC): 27.6]","count":"1 through 10","median_amount":30634.5,"10th_percentile":30634.5,"90th_percentile":30634.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"First Health/Coventry","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":24883.05,"10th_percentile":24883.05,"90th_percentile":24883.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 60.4] [Cardiac Cath (%BC): 60.4] [Observation (%BC): 53.7] [Emergency Department (%BC): 53.7] [Occupational Therapy (%BC): 60.4] [Physical Therapy (%BC): 60.4] [Respiratory Services/Therapy  (%BC): 60.4] [Speech Therapy (%BC): 60.4] [All Other OP (%BC): 60.4]","count":"1 through 10","median_amount":61252.61,"10th_percentile":61252.61,"90th_percentile":61252.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 5 Musculoskeletal Procedures","code_information":[{"code":"5115","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 33.9] [Cardiac Cath (%BC): 33.9] [Observation (%BC): 57.7] [Emergency Department (%BC): 57.7] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 33.9] [Occupational Therapy (%BC): 33.9] [Physical Therapy (%BC): 33.9] [Respiratory Services/Therapy  (%BC): 33.9] [Speech Therapy (%BC): 33.9] [All Other OP (%BC): 33.9]","count":"1 through 10","median_amount":32812.04,"10th_percentile":32812.04,"90th_percentile":42703.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":13345.14,"10th_percentile":13345.14,"90th_percentile":13345.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Avmed","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Baycare Plus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 30.92] [Cardiac Cath (%BC): 30.92] [Lithotripsy (%BC): 30.92] [PTCA (%BC): 30.92] [Observation (%BC): 47.84] [Emergency Department (%BC): 47.84] [Other Cardiac Testing (%BC): 41.01] [EEG (%BC): 41.01] [Chemotherapy (%BC): 41.01] [Nuclear Medicine (%BC): 15.94] [Radiation Therapy  (%BC): 41.01] [CT OP Scan (%BC): 15.94] [MRI OP (%BC): 15.94] [Positron Emission Tomography (%BC): 15.94] [Radiology (%BC): 15.94] [Laboratory (%BC): 41.01] [Occupational Therapy (%BC): 41.01] [Physical Therapy (%BC): 41.01] [Speech Therapy (%BC): 41.01] [Other Outpatient Implant (%BC): 24.52] [IV Therapy (%BC): 41.01] [All Other OP (%BC): 41.01]","count":"1 through 10","median_amount":46225.48,"10th_percentile":46225.48,"90th_percentile":53250.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50] [All Other OP (%BC): 16.218]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 45.89] [Cardiac Cath (%BC): 45.89] [Lithotripsy (%BC): 45.89] [PTCA (%BC): 45.89] [Observation (%BC): 55.14] [Emergency Department (%BC): 55.14] [Other Cardiac Testing (%BC): 50.30] [EEG (%BC): 50.30] [Chemotherapy (%BC): 50.30] [Nuclear Medicine (%BC): 18.93] [Radiation Therapy  (%BC): 50.30] [CT OP Scan (%BC): 18.93] [MRI OP (%BC): 18.93] [Positron Emission Tomography (%BC): 18.93] [Radiology (%BC): 18.93] [Laboratory (%BC): 50.30] [Occupational Therapy (%BC): 50.30] [Physical Therapy (%BC): 50.30] [Speech Therapy (%BC): 50.30] [Other Outpatient Implant (%BC): 24.52] [IV Therapy (%BC): 50.30] [All Other OP (%BC): 50.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 27.6] [Cardiac Cath (%BC): 27.6] [Observation (%BC): 42.8] [Emergency Department (%BC): 42.8] [Occupational Therapy (%BC): 27.6] [Physical Therapy (%BC): 27.6] [Respiratory Services/Therapy  (%BC): 27.6] [Speech Therapy (%BC): 27.6] [All Other OP (%BC): 27.6]","count":"1 through 10","median_amount":1414.32,"10th_percentile":1414.32,"90th_percentile":31947.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"First Health/Coventry","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":20584.97,"10th_percentile":12865.01,"90th_percentile":133098.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 60.4] [Cardiac Cath (%BC): 60.4] [Observation (%BC): 53.7] [Emergency Department (%BC): 53.7] [Occupational Therapy (%BC): 60.4] [Physical Therapy (%BC): 60.4] [Respiratory Services/Therapy  (%BC): 60.4] [Speech Therapy (%BC): 60.4] [All Other OP (%BC): 60.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Vascular Procedures","code_information":[{"code":"5181","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 33.9] [Cardiac Cath (%BC): 33.9] [Observation (%BC): 57.7] [Emergency Department (%BC): 57.7] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 33.9] [Occupational Therapy (%BC): 33.9] [Physical Therapy (%BC): 33.9] [Respiratory Services/Therapy  (%BC): 33.9] [Speech Therapy (%BC): 33.9] [All Other OP (%BC): 33.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Avmed","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Baycare Plus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 30.92] [Cardiac Cath (%BC): 30.92] [Lithotripsy (%BC): 30.92] [PTCA (%BC): 30.92] [Observation (%BC): 47.84] [Emergency Department (%BC): 47.84] [Other Cardiac Testing (%BC): 41.01] [EEG (%BC): 41.01] [Chemotherapy (%BC): 41.01] [Nuclear Medicine (%BC): 15.94] [Radiation Therapy  (%BC): 41.01] [CT OP Scan (%BC): 15.94] [MRI OP (%BC): 15.94] [Positron Emission Tomography (%BC): 15.94] [Radiology (%BC): 15.94] [Laboratory (%BC): 41.01] [Occupational Therapy (%BC): 41.01] [Physical Therapy (%BC): 41.01] [Speech Therapy (%BC): 41.01] [Other Outpatient Implant (%BC): 24.52] [IV Therapy (%BC): 41.01] [All Other OP (%BC): 41.01]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50] [All Other OP (%BC): 16.218]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 45.89] [Cardiac Cath (%BC): 45.89] [Lithotripsy (%BC): 45.89] [PTCA (%BC): 45.89] [Observation (%BC): 55.14] [Emergency Department (%BC): 55.14] [Other Cardiac Testing (%BC): 50.30] [EEG (%BC): 50.30] [Chemotherapy (%BC): 50.30] [Nuclear Medicine (%BC): 18.93] [Radiation Therapy  (%BC): 50.30] [CT OP Scan (%BC): 18.93] [MRI OP (%BC): 18.93] [Positron Emission Tomography (%BC): 18.93] [Radiology (%BC): 18.93] [Laboratory (%BC): 50.30] [Occupational Therapy (%BC): 50.30] [Physical Therapy (%BC): 50.30] [Speech Therapy (%BC): 50.30] [Other Outpatient Implant (%BC): 24.52] [IV Therapy (%BC): 50.30] [All Other OP (%BC): 50.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 27.6] [Cardiac Cath (%BC): 27.6] [Observation (%BC): 42.8] [Emergency Department (%BC): 42.8] [Occupational Therapy (%BC): 27.6] [Physical Therapy (%BC): 27.6] [Respiratory Services/Therapy  (%BC): 27.6] [Speech Therapy (%BC): 27.6] [All Other OP (%BC): 27.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":498.89,"10th_percentile":498.89,"90th_percentile":498.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 60.4] [Cardiac Cath (%BC): 60.4] [Observation (%BC): 53.7] [Emergency Department (%BC): 53.7] [Occupational Therapy (%BC): 60.4] [Physical Therapy (%BC): 60.4] [Respiratory Services/Therapy  (%BC): 60.4] [Speech Therapy (%BC): 60.4] [All Other OP (%BC): 60.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Endovascular Procedures","code_information":[{"code":"5191","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 33.9] [Cardiac Cath (%BC): 33.9] [Observation (%BC): 57.7] [Emergency Department (%BC): 57.7] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 33.9] [Occupational Therapy (%BC): 33.9] [Physical Therapy (%BC): 33.9] [Respiratory Services/Therapy  (%BC): 33.9] [Speech Therapy (%BC): 33.9] [All Other OP (%BC): 33.9]","count":"1 through 10","median_amount":7328.47,"10th_percentile":7328.47,"90th_percentile":7328.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":1612.65,"10th_percentile":1612.65,"90th_percentile":1612.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3296.36,"10th_percentile":3296.36,"90th_percentile":3298.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Avmed","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Baycare Plus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3228.57,"10th_percentile":3228.57,"90th_percentile":3228.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 30.92] [Cardiac Cath (%BC): 30.92] [Lithotripsy (%BC): 30.92] [PTCA (%BC): 30.92] [Observation (%BC): 47.84] [Emergency Department (%BC): 47.84] [Other Cardiac Testing (%BC): 41.01] [EEG (%BC): 41.01] [Chemotherapy (%BC): 41.01] [Nuclear Medicine (%BC): 15.94] [Radiation Therapy  (%BC): 41.01] [CT OP Scan (%BC): 15.94] [MRI OP (%BC): 15.94] [Positron Emission Tomography (%BC): 15.94] [Radiology (%BC): 15.94] [Laboratory (%BC): 41.01] [Occupational Therapy (%BC): 41.01] [Physical Therapy (%BC): 41.01] [Speech Therapy (%BC): 41.01] [Other Outpatient Implant (%BC): 24.52] [IV Therapy (%BC): 41.01] [All Other OP (%BC): 41.01]","count":"1 through 10","median_amount":9065.0,"10th_percentile":8967.66,"90th_percentile":18447.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50] [All Other OP (%BC): 16.218]","count":"1 through 10","median_amount":3293.14,"10th_percentile":3293.14,"90th_percentile":3293.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 45.89] [Cardiac Cath (%BC): 45.89] [Lithotripsy (%BC): 45.89] [PTCA (%BC): 45.89] [Observation (%BC): 55.14] [Emergency Department (%BC): 55.14] [Other Cardiac Testing (%BC): 50.30] [EEG (%BC): 50.30] [Chemotherapy (%BC): 50.30] [Nuclear Medicine (%BC): 18.93] [Radiation Therapy  (%BC): 50.30] [CT OP Scan (%BC): 18.93] [MRI OP (%BC): 18.93] [Positron Emission Tomography (%BC): 18.93] [Radiology (%BC): 18.93] [Laboratory (%BC): 50.30] [Occupational Therapy (%BC): 50.30] [Physical Therapy (%BC): 50.30] [Speech Therapy (%BC): 50.30] [Other Outpatient Implant (%BC): 24.52] [IV Therapy (%BC): 50.30] [All Other OP (%BC): 50.30]","count":"1 through 10","median_amount":13589.12,"10th_percentile":13589.12,"90th_percentile":13589.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3197.78,"10th_percentile":3197.78,"90th_percentile":3197.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 27.6] [Cardiac Cath (%BC): 27.6] [Observation (%BC): 42.8] [Emergency Department (%BC): 42.8] [Occupational Therapy (%BC): 27.6] [Physical Therapy (%BC): 27.6] [Respiratory Services/Therapy  (%BC): 27.6] [Speech Therapy (%BC): 27.6] [All Other OP (%BC): 27.6]","count":"1 through 10","median_amount":9831.24,"10th_percentile":9831.24,"90th_percentile":9831.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"First Health/Coventry","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":7167.43,"10th_percentile":7167.43,"90th_percentile":7273.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":1672.49,"10th_percentile":1672.49,"90th_percentile":1672.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 60.4] [Cardiac Cath (%BC): 60.4] [Observation (%BC): 53.7] [Emergency Department (%BC): 53.7] [Occupational Therapy (%BC): 60.4] [Physical Therapy (%BC): 60.4] [Respiratory Services/Therapy  (%BC): 60.4] [Speech Therapy (%BC): 60.4] [All Other OP (%BC): 60.4]","count":"1 through 10","median_amount":18344.55,"10th_percentile":18344.55,"90th_percentile":18344.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3339.89,"10th_percentile":3339.89,"90th_percentile":3344.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Endovascular Procedures","code_information":[{"code":"5192","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 33.9] [Cardiac Cath (%BC): 33.9] [Observation (%BC): 57.7] [Emergency Department (%BC): 57.7] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 33.9] [Occupational Therapy (%BC): 33.9] [Physical Therapy (%BC): 33.9] [Respiratory Services/Therapy  (%BC): 33.9] [Speech Therapy (%BC): 33.9] [All Other OP (%BC): 33.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Avmed","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Baycare Plus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 30.92] [Cardiac Cath (%BC): 30.92] [Lithotripsy (%BC): 30.92] [PTCA (%BC): 30.92] [Observation (%BC): 47.84] [Emergency Department (%BC): 47.84] [Other Cardiac Testing (%BC): 41.01] [EEG (%BC): 41.01] [Chemotherapy (%BC): 41.01] [Nuclear Medicine (%BC): 15.94] [Radiation Therapy  (%BC): 41.01] [CT OP Scan (%BC): 15.94] [MRI OP (%BC): 15.94] [Positron Emission Tomography (%BC): 15.94] [Radiology (%BC): 15.94] [Laboratory (%BC): 41.01] [Occupational Therapy (%BC): 41.01] [Physical Therapy (%BC): 41.01] [Speech Therapy (%BC): 41.01] [Other Outpatient Implant (%BC): 24.52] [IV Therapy (%BC): 41.01] [All Other OP (%BC): 41.01]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50] [All Other OP (%BC): 16.218]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 45.89] [Cardiac Cath (%BC): 45.89] [Lithotripsy (%BC): 45.89] [PTCA (%BC): 45.89] [Observation (%BC): 55.14] [Emergency Department (%BC): 55.14] [Other Cardiac Testing (%BC): 50.30] [EEG (%BC): 50.30] [Chemotherapy (%BC): 50.30] [Nuclear Medicine (%BC): 18.93] [Radiation Therapy  (%BC): 50.30] [CT OP Scan (%BC): 18.93] [MRI OP (%BC): 18.93] [Positron Emission Tomography (%BC): 18.93] [Radiology (%BC): 18.93] [Laboratory (%BC): 50.30] [Occupational Therapy (%BC): 50.30] [Physical Therapy (%BC): 50.30] [Speech Therapy (%BC): 50.30] [Other Outpatient Implant (%BC): 24.52] [IV Therapy (%BC): 50.30] [All Other OP (%BC): 50.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 27.6] [Cardiac Cath (%BC): 27.6] [Observation (%BC): 42.8] [Emergency Department (%BC): 42.8] [Occupational Therapy (%BC): 27.6] [Physical Therapy (%BC): 27.6] [Respiratory Services/Therapy  (%BC): 27.6] [Speech Therapy (%BC): 27.6] [All Other OP (%BC): 27.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 60.4] [Cardiac Cath (%BC): 60.4] [Observation (%BC): 53.7] [Emergency Department (%BC): 53.7] [Occupational Therapy (%BC): 60.4] [Physical Therapy (%BC): 60.4] [Respiratory Services/Therapy  (%BC): 60.4] [Speech Therapy (%BC): 60.4] [All Other OP (%BC): 60.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":5889.04,"10th_percentile":5889.04,"90th_percentile":5889.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 3 Endovascular Procedures","code_information":[{"code":"5193","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 33.9] [Cardiac Cath (%BC): 33.9] [Observation (%BC): 57.7] [Emergency Department (%BC): 57.7] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 33.9] [Occupational Therapy (%BC): 33.9] [Physical Therapy (%BC): 33.9] [Respiratory Services/Therapy  (%BC): 33.9] [Speech Therapy (%BC): 33.9] [All Other OP (%BC): 33.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Avmed","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Baycare Plus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 30.92] [Cardiac Cath (%BC): 30.92] [Lithotripsy (%BC): 30.92] [PTCA (%BC): 30.92] [Observation (%BC): 47.84] [Emergency Department (%BC): 47.84] [Other Cardiac Testing (%BC): 41.01] [EEG (%BC): 41.01] [Chemotherapy (%BC): 41.01] [Nuclear Medicine (%BC): 15.94] [Radiation Therapy  (%BC): 41.01] [CT OP Scan (%BC): 15.94] [MRI OP (%BC): 15.94] [Positron Emission Tomography (%BC): 15.94] [Radiology (%BC): 15.94] [Laboratory (%BC): 41.01] [Occupational Therapy (%BC): 41.01] [Physical Therapy (%BC): 41.01] [Speech Therapy (%BC): 41.01] [Other Outpatient Implant (%BC): 24.52] [IV Therapy (%BC): 41.01] [All Other OP (%BC): 41.01]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50] [All Other OP (%BC): 16.218]","count":"1 through 10","median_amount":11619.13,"10th_percentile":11619.13,"90th_percentile":11619.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 45.89] [Cardiac Cath (%BC): 45.89] [Lithotripsy (%BC): 45.89] [PTCA (%BC): 45.89] [Observation (%BC): 55.14] [Emergency Department (%BC): 55.14] [Other Cardiac Testing (%BC): 50.30] [EEG (%BC): 50.30] [Chemotherapy (%BC): 50.30] [Nuclear Medicine (%BC): 18.93] [Radiation Therapy  (%BC): 50.30] [CT OP Scan (%BC): 18.93] [MRI OP (%BC): 18.93] [Positron Emission Tomography (%BC): 18.93] [Radiology (%BC): 18.93] [Laboratory (%BC): 50.30] [Occupational Therapy (%BC): 50.30] [Physical Therapy (%BC): 50.30] [Speech Therapy (%BC): 50.30] [Other Outpatient Implant (%BC): 24.52] [IV Therapy (%BC): 50.30] [All Other OP (%BC): 50.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 27.6] [Cardiac Cath (%BC): 27.6] [Observation (%BC): 42.8] [Emergency Department (%BC): 42.8] [Occupational Therapy (%BC): 27.6] [Physical Therapy (%BC): 27.6] [Respiratory Services/Therapy  (%BC): 27.6] [Speech Therapy (%BC): 27.6] [All Other OP (%BC): 27.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":7349.91,"10th_percentile":7349.91,"90th_percentile":7349.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 60.4] [Cardiac Cath (%BC): 60.4] [Observation (%BC): 53.7] [Emergency Department (%BC): 53.7] [Occupational Therapy (%BC): 60.4] [Physical Therapy (%BC): 60.4] [Respiratory Services/Therapy  (%BC): 60.4] [Speech Therapy (%BC): 60.4] [All Other OP (%BC): 60.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Pacemaker and Similar Procedures","code_information":[{"code":"5222","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 33.9] [Cardiac Cath (%BC): 33.9] [Observation (%BC): 57.7] [Emergency Department (%BC): 57.7] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 33.9] [Occupational Therapy (%BC): 33.9] [Physical Therapy (%BC): 33.9] [Respiratory Services/Therapy  (%BC): 33.9] [Speech Therapy (%BC): 33.9] [All Other OP (%BC): 33.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Avmed","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Baycare Plus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 30.92] [Cardiac Cath (%BC): 30.92] [Lithotripsy (%BC): 30.92] [PTCA (%BC): 30.92] [Observation (%BC): 47.84] [Emergency Department (%BC): 47.84] [Other Cardiac Testing (%BC): 41.01] [EEG (%BC): 41.01] [Chemotherapy (%BC): 41.01] [Nuclear Medicine (%BC): 15.94] [Radiation Therapy  (%BC): 41.01] [CT OP Scan (%BC): 15.94] [MRI OP (%BC): 15.94] [Positron Emission Tomography (%BC): 15.94] [Radiology (%BC): 15.94] [Laboratory (%BC): 41.01] [Occupational Therapy (%BC): 41.01] [Physical Therapy (%BC): 41.01] [Speech Therapy (%BC): 41.01] [Other Outpatient Implant (%BC): 24.52] [IV Therapy (%BC): 41.01] [All Other OP (%BC): 41.01]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50] [All Other OP (%BC): 16.218]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 45.89] [Cardiac Cath (%BC): 45.89] [Lithotripsy (%BC): 45.89] [PTCA (%BC): 45.89] [Observation (%BC): 55.14] [Emergency Department (%BC): 55.14] [Other Cardiac Testing (%BC): 50.30] [EEG (%BC): 50.30] [Chemotherapy (%BC): 50.30] [Nuclear Medicine (%BC): 18.93] [Radiation Therapy  (%BC): 50.30] [CT OP Scan (%BC): 18.93] [MRI OP (%BC): 18.93] [Positron Emission Tomography (%BC): 18.93] [Radiology (%BC): 18.93] [Laboratory (%BC): 50.30] [Occupational Therapy (%BC): 50.30] [Physical Therapy (%BC): 50.30] [Speech Therapy (%BC): 50.30] [Other Outpatient Implant (%BC): 24.52] [IV Therapy (%BC): 50.30] [All Other OP (%BC): 50.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 27.6] [Cardiac Cath (%BC): 27.6] [Observation (%BC): 42.8] [Emergency Department (%BC): 42.8] [Occupational Therapy (%BC): 27.6] [Physical Therapy (%BC): 27.6] [Respiratory Services/Therapy  (%BC): 27.6] [Speech Therapy (%BC): 27.6] [All Other OP (%BC): 27.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 60.4] [Cardiac Cath (%BC): 60.4] [Observation (%BC): 53.7] [Emergency Department (%BC): 53.7] [Occupational Therapy (%BC): 60.4] [Physical Therapy (%BC): 60.4] [Respiratory Services/Therapy  (%BC): 60.4] [Speech Therapy (%BC): 60.4] [All Other OP (%BC): 60.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":8583.06,"10th_percentile":8583.06,"90th_percentile":8583.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 3 Pacemaker and Similar Procedures","code_information":[{"code":"5223","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 33.9] [Cardiac Cath (%BC): 33.9] [Observation (%BC): 57.7] [Emergency Department (%BC): 57.7] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 33.9] [Occupational Therapy (%BC): 33.9] [Physical Therapy (%BC): 33.9] [Respiratory Services/Therapy  (%BC): 33.9] [Speech Therapy (%BC): 33.9] [All Other OP (%BC): 33.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":10706.59,"10th_percentile":10706.59,"90th_percentile":10706.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Avmed","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Baycare Plus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 30.92] [Cardiac Cath (%BC): 30.92] [Lithotripsy (%BC): 30.92] [PTCA (%BC): 30.92] [Observation (%BC): 47.84] [Emergency Department (%BC): 47.84] [Other Cardiac Testing (%BC): 41.01] [EEG (%BC): 41.01] [Chemotherapy (%BC): 41.01] [Nuclear Medicine (%BC): 15.94] [Radiation Therapy  (%BC): 41.01] [CT OP Scan (%BC): 15.94] [MRI OP (%BC): 15.94] [Positron Emission Tomography (%BC): 15.94] [Radiology (%BC): 15.94] [Laboratory (%BC): 41.01] [Occupational Therapy (%BC): 41.01] [Physical Therapy (%BC): 41.01] [Speech Therapy (%BC): 41.01] [Other Outpatient Implant (%BC): 24.52] [IV Therapy (%BC): 41.01] [All Other OP (%BC): 41.01]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50] [All Other OP (%BC): 16.218]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 45.89] [Cardiac Cath (%BC): 45.89] [Lithotripsy (%BC): 45.89] [PTCA (%BC): 45.89] [Observation (%BC): 55.14] [Emergency Department (%BC): 55.14] [Other Cardiac Testing (%BC): 50.30] [EEG (%BC): 50.30] [Chemotherapy (%BC): 50.30] [Nuclear Medicine (%BC): 18.93] [Radiation Therapy  (%BC): 50.30] [CT OP Scan (%BC): 18.93] [MRI OP (%BC): 18.93] [Positron Emission Tomography (%BC): 18.93] [Radiology (%BC): 18.93] [Laboratory (%BC): 50.30] [Occupational Therapy (%BC): 50.30] [Physical Therapy (%BC): 50.30] [Speech Therapy (%BC): 50.30] [Other Outpatient Implant (%BC): 24.52] [IV Therapy (%BC): 50.30] [All Other OP (%BC): 50.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 27.6] [Cardiac Cath (%BC): 27.6] [Observation (%BC): 42.8] [Emergency Department (%BC): 42.8] [Occupational Therapy (%BC): 27.6] [Physical Therapy (%BC): 27.6] [Respiratory Services/Therapy  (%BC): 27.6] [Speech Therapy (%BC): 27.6] [All Other OP (%BC): 27.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 60.4] [Cardiac Cath (%BC): 60.4] [Observation (%BC): 53.7] [Emergency Department (%BC): 53.7] [Occupational Therapy (%BC): 60.4] [Physical Therapy (%BC): 60.4] [Respiratory Services/Therapy  (%BC): 60.4] [Speech Therapy (%BC): 60.4] [All Other OP (%BC): 60.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Upper GI Procedures","code_information":[{"code":"5301","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 33.9] [Cardiac Cath (%BC): 33.9] [Observation (%BC): 57.7] [Emergency Department (%BC): 57.7] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 33.9] [Occupational Therapy (%BC): 33.9] [Physical Therapy (%BC): 33.9] [Respiratory Services/Therapy  (%BC): 33.9] [Speech Therapy (%BC): 33.9] [All Other OP (%BC): 33.9]","count":"1 through 10","median_amount":5985.77,"10th_percentile":4866.02,"90th_percentile":7769.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":657.05,"10th_percentile":657.05,"90th_percentile":657.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":964.97,"10th_percentile":959.17,"90th_percentile":1397.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Avmed","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Baycare Plus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 30.92] [Cardiac Cath (%BC): 30.92] [Lithotripsy (%BC): 30.92] [PTCA (%BC): 30.92] [Observation (%BC): 47.84] [Emergency Department (%BC): 47.84] [Other Cardiac Testing (%BC): 41.01] [EEG (%BC): 41.01] [Chemotherapy (%BC): 41.01] [Nuclear Medicine (%BC): 15.94] [Radiation Therapy  (%BC): 41.01] [CT OP Scan (%BC): 15.94] [MRI OP (%BC): 15.94] [Positron Emission Tomography (%BC): 15.94] [Radiology (%BC): 15.94] [Laboratory (%BC): 41.01] [Occupational Therapy (%BC): 41.01] [Physical Therapy (%BC): 41.01] [Speech Therapy (%BC): 41.01] [Other Outpatient Implant (%BC): 24.52] [IV Therapy (%BC): 41.01] [All Other OP (%BC): 41.01]","count":"1 through 10","median_amount":7598.7,"10th_percentile":6941.56,"90th_percentile":23057.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50] [All Other OP (%BC): 16.218]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 45.89] [Cardiac Cath (%BC): 45.89] [Lithotripsy (%BC): 45.89] [PTCA (%BC): 45.89] [Observation (%BC): 55.14] [Emergency Department (%BC): 55.14] [Other Cardiac Testing (%BC): 50.30] [EEG (%BC): 50.30] [Chemotherapy (%BC): 50.30] [Nuclear Medicine (%BC): 18.93] [Radiation Therapy  (%BC): 50.30] [CT OP Scan (%BC): 18.93] [MRI OP (%BC): 18.93] [Positron Emission Tomography (%BC): 18.93] [Radiology (%BC): 18.93] [Laboratory (%BC): 50.30] [Occupational Therapy (%BC): 50.30] [Physical Therapy (%BC): 50.30] [Speech Therapy (%BC): 50.30] [Other Outpatient Implant (%BC): 24.52] [IV Therapy (%BC): 50.30] [All Other OP (%BC): 50.30]","count":"1 through 10","median_amount":8248.45,"10th_percentile":8248.45,"90th_percentile":8248.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":931.69,"10th_percentile":931.69,"90th_percentile":931.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 27.6] [Cardiac Cath (%BC): 27.6] [Observation (%BC): 42.8] [Emergency Department (%BC): 42.8] [Occupational Therapy (%BC): 27.6] [Physical Therapy (%BC): 27.6] [Respiratory Services/Therapy  (%BC): 27.6] [Speech Therapy (%BC): 27.6] [All Other OP (%BC): 27.6]","count":"1 through 10","median_amount":5418.04,"10th_percentile":5418.04,"90th_percentile":5418.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"First Health/Coventry","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1718.45,"10th_percentile":1718.45,"90th_percentile":1718.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":681.85,"10th_percentile":681.85,"90th_percentile":681.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":924.28,"10th_percentile":924.28,"90th_percentile":924.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2089.24,"10th_percentile":2089.24,"90th_percentile":2097.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":681.43,"10th_percentile":681.43,"90th_percentile":681.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 60.4] [Cardiac Cath (%BC): 60.4] [Observation (%BC): 53.7] [Emergency Department (%BC): 53.7] [Occupational Therapy (%BC): 60.4] [Physical Therapy (%BC): 60.4] [Respiratory Services/Therapy  (%BC): 60.4] [Speech Therapy (%BC): 60.4] [All Other OP (%BC): 60.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":975.44,"10th_percentile":197.63,"90th_percentile":1462.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Upper GI Procedures","code_information":[{"code":"5302","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 33.9] [Cardiac Cath (%BC): 33.9] [Observation (%BC): 57.7] [Emergency Department (%BC): 57.7] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 33.9] [Occupational Therapy (%BC): 33.9] [Physical Therapy (%BC): 33.9] [Respiratory Services/Therapy  (%BC): 33.9] [Speech Therapy (%BC): 33.9] [All Other OP (%BC): 33.9]","count":"1 through 10","median_amount":9261.2,"10th_percentile":9261.2,"90th_percentile":9261.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1940.72,"10th_percentile":1940.72,"90th_percentile":1940.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Avmed","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Baycare Plus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 30.92] [Cardiac Cath (%BC): 30.92] [Lithotripsy (%BC): 30.92] [PTCA (%BC): 30.92] [Observation (%BC): 47.84] [Emergency Department (%BC): 47.84] [Other Cardiac Testing (%BC): 41.01] [EEG (%BC): 41.01] [Chemotherapy (%BC): 41.01] [Nuclear Medicine (%BC): 15.94] [Radiation Therapy  (%BC): 41.01] [CT OP Scan (%BC): 15.94] [MRI OP (%BC): 15.94] [Positron Emission Tomography (%BC): 15.94] [Radiology (%BC): 15.94] [Laboratory (%BC): 41.01] [Occupational Therapy (%BC): 41.01] [Physical Therapy (%BC): 41.01] [Speech Therapy (%BC): 41.01] [Other Outpatient Implant (%BC): 24.52] [IV Therapy (%BC): 41.01] [All Other OP (%BC): 41.01]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50] [All Other OP (%BC): 16.218]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 45.89] [Cardiac Cath (%BC): 45.89] [Lithotripsy (%BC): 45.89] [PTCA (%BC): 45.89] [Observation (%BC): 55.14] [Emergency Department (%BC): 55.14] [Other Cardiac Testing (%BC): 50.30] [EEG (%BC): 50.30] [Chemotherapy (%BC): 50.30] [Nuclear Medicine (%BC): 18.93] [Radiation Therapy  (%BC): 50.30] [CT OP Scan (%BC): 18.93] [MRI OP (%BC): 18.93] [Positron Emission Tomography (%BC): 18.93] [Radiology (%BC): 18.93] [Laboratory (%BC): 50.30] [Occupational Therapy (%BC): 50.30] [Physical Therapy (%BC): 50.30] [Speech Therapy (%BC): 50.30] [Other Outpatient Implant (%BC): 24.52] [IV Therapy (%BC): 50.30] [All Other OP (%BC): 50.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 27.6] [Cardiac Cath (%BC): 27.6] [Observation (%BC): 42.8] [Emergency Department (%BC): 42.8] [Occupational Therapy (%BC): 27.6] [Physical Therapy (%BC): 27.6] [Respiratory Services/Therapy  (%BC): 27.6] [Speech Therapy (%BC): 27.6] [All Other OP (%BC): 27.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 60.4] [Cardiac Cath (%BC): 60.4] [Observation (%BC): 53.7] [Emergency Department (%BC): 53.7] [Occupational Therapy (%BC): 60.4] [Physical Therapy (%BC): 60.4] [Respiratory Services/Therapy  (%BC): 60.4] [Speech Therapy (%BC): 60.4] [All Other OP (%BC): 60.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1967.38,"10th_percentile":1967.38,"90th_percentile":1971.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Lower GI Procedures","code_information":[{"code":"5311","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 33.9] [Cardiac Cath (%BC): 33.9] [Observation (%BC): 57.7] [Emergency Department (%BC): 57.7] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 33.9] [Occupational Therapy (%BC): 33.9] [Physical Therapy (%BC): 33.9] [Respiratory Services/Therapy  (%BC): 33.9] [Speech Therapy (%BC): 33.9] [All Other OP (%BC): 33.9]","count":"1 through 10","median_amount":5983.85,"10th_percentile":4467.03,"90th_percentile":7427.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":644.8,"10th_percentile":644.8,"90th_percentile":644.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1429.54,"10th_percentile":1429.54,"90th_percentile":1429.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Avmed","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Baycare Plus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 30.92] [Cardiac Cath (%BC): 30.92] [Lithotripsy (%BC): 30.92] [PTCA (%BC): 30.92] [Observation (%BC): 47.84] [Emergency Department (%BC): 47.84] [Other Cardiac Testing (%BC): 41.01] [EEG (%BC): 41.01] [Chemotherapy (%BC): 41.01] [Nuclear Medicine (%BC): 15.94] [Radiation Therapy  (%BC): 41.01] [CT OP Scan (%BC): 15.94] [MRI OP (%BC): 15.94] [Positron Emission Tomography (%BC): 15.94] [Radiology (%BC): 15.94] [Laboratory (%BC): 41.01] [Occupational Therapy (%BC): 41.01] [Physical Therapy (%BC): 41.01] [Speech Therapy (%BC): 41.01] [Other Outpatient Implant (%BC): 24.52] [IV Therapy (%BC): 41.01] [All Other OP (%BC): 41.01]","count":"1 through 10","median_amount":8770.53,"10th_percentile":6971.02,"90th_percentile":10633.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50] [All Other OP (%BC): 16.218]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 45.89] [Cardiac Cath (%BC): 45.89] [Lithotripsy (%BC): 45.89] [PTCA (%BC): 45.89] [Observation (%BC): 55.14] [Emergency Department (%BC): 55.14] [Other Cardiac Testing (%BC): 50.30] [EEG (%BC): 50.30] [Chemotherapy (%BC): 50.30] [Nuclear Medicine (%BC): 18.93] [Radiation Therapy  (%BC): 50.30] [CT OP Scan (%BC): 18.93] [MRI OP (%BC): 18.93] [Positron Emission Tomography (%BC): 18.93] [Radiology (%BC): 18.93] [Laboratory (%BC): 50.30] [Occupational Therapy (%BC): 50.30] [Physical Therapy (%BC): 50.30] [Speech Therapy (%BC): 50.30] [Other Outpatient Implant (%BC): 24.52] [IV Therapy (%BC): 50.30] [All Other OP (%BC): 50.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 27.6] [Cardiac Cath (%BC): 27.6] [Observation (%BC): 42.8] [Emergency Department (%BC): 42.8] [Occupational Therapy (%BC): 27.6] [Physical Therapy (%BC): 27.6] [Respiratory Services/Therapy  (%BC): 27.6] [Speech Therapy (%BC): 27.6] [All Other OP (%BC): 27.6]","count":"1 through 10","median_amount":5128.35,"10th_percentile":5128.35,"90th_percentile":5128.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"First Health/Coventry","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":669.14,"10th_percentile":669.14,"90th_percentile":669.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":668.72,"10th_percentile":668.72,"90th_percentile":668.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 60.4] [Cardiac Cath (%BC): 60.4] [Observation (%BC): 53.7] [Emergency Department (%BC): 53.7] [Occupational Therapy (%BC): 60.4] [Physical Therapy (%BC): 60.4] [Respiratory Services/Therapy  (%BC): 60.4] [Speech Therapy (%BC): 60.4] [All Other OP (%BC): 60.4]","count":"1 through 10","median_amount":12098.69,"10th_percentile":12098.69,"90th_percentile":12098.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1443.2,"10th_percentile":1443.2,"90th_percentile":1443.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Lower GI Procedures","code_information":[{"code":"5312","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 33.9] [Cardiac Cath (%BC): 33.9] [Observation (%BC): 57.7] [Emergency Department (%BC): 57.7] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 33.9] [Occupational Therapy (%BC): 33.9] [Physical Therapy (%BC): 33.9] [Respiratory Services/Therapy  (%BC): 33.9] [Speech Therapy (%BC): 33.9] [All Other OP (%BC): 33.9]","count":"12","median_amount":7890.52,"10th_percentile":5775.72,"90th_percentile":8366.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":967.2,"10th_percentile":967.2,"90th_percentile":967.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1210.27,"10th_percentile":1206.26,"90th_percentile":1809.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Avmed","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Baycare Plus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 30.92] [Cardiac Cath (%BC): 30.92] [Lithotripsy (%BC): 30.92] [PTCA (%BC): 30.92] [Observation (%BC): 47.84] [Emergency Department (%BC): 47.84] [Other Cardiac Testing (%BC): 41.01] [EEG (%BC): 41.01] [Chemotherapy (%BC): 41.01] [Nuclear Medicine (%BC): 15.94] [Radiation Therapy  (%BC): 41.01] [CT OP Scan (%BC): 15.94] [MRI OP (%BC): 15.94] [Positron Emission Tomography (%BC): 15.94] [Radiology (%BC): 15.94] [Laboratory (%BC): 41.01] [Occupational Therapy (%BC): 41.01] [Physical Therapy (%BC): 41.01] [Speech Therapy (%BC): 41.01] [Other Outpatient Implant (%BC): 24.52] [IV Therapy (%BC): 41.01] [All Other OP (%BC): 41.01]","count":"18","median_amount":8132.29,"10th_percentile":6804.85,"90th_percentile":10894.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50] [All Other OP (%BC): 16.218]","count":"1 through 10","median_amount":1687.17,"10th_percentile":1207.21,"90th_percentile":1810.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 45.89] [Cardiac Cath (%BC): 45.89] [Lithotripsy (%BC): 45.89] [PTCA (%BC): 45.89] [Observation (%BC): 55.14] [Emergency Department (%BC): 55.14] [Other Cardiac Testing (%BC): 50.30] [EEG (%BC): 50.30] [Chemotherapy (%BC): 50.30] [Nuclear Medicine (%BC): 18.93] [Radiation Therapy  (%BC): 50.30] [CT OP Scan (%BC): 18.93] [MRI OP (%BC): 18.93] [Positron Emission Tomography (%BC): 18.93] [Radiology (%BC): 18.93] [Laboratory (%BC): 50.30] [Occupational Therapy (%BC): 50.30] [Physical Therapy (%BC): 50.30] [Speech Therapy (%BC): 50.30] [Other Outpatient Implant (%BC): 24.52] [IV Therapy (%BC): 50.30] [All Other OP (%BC): 50.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 27.6] [Cardiac Cath (%BC): 27.6] [Observation (%BC): 42.8] [Emergency Department (%BC): 42.8] [Occupational Therapy (%BC): 27.6] [Physical Therapy (%BC): 27.6] [Respiratory Services/Therapy  (%BC): 27.6] [Speech Therapy (%BC): 27.6] [All Other OP (%BC): 27.6]","count":"1 through 10","median_amount":6204.17,"10th_percentile":1651.95,"90th_percentile":9118.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"First Health/Coventry","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1163.8,"10th_percentile":1159.87,"90th_percentile":1637.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2168.32,"10th_percentile":2161.14,"90th_percentile":3241.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":1003.71,"10th_percentile":1003.71,"90th_percentile":1003.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1233.55,"10th_percentile":1233.55,"90th_percentile":1726.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3672.08,"10th_percentile":3672.08,"90th_percentile":3672.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":668.72,"10th_percentile":668.72,"90th_percentile":668.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 60.4] [Cardiac Cath (%BC): 60.4] [Observation (%BC): 53.7] [Emergency Department (%BC): 53.7] [Occupational Therapy (%BC): 60.4] [Physical Therapy (%BC): 60.4] [Respiratory Services/Therapy  (%BC): 60.4] [Speech Therapy (%BC): 60.4] [All Other OP (%BC): 60.4]","count":"1 through 10","median_amount":11726.71,"10th_percentile":11726.71,"90th_percentile":15967.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1222.0,"10th_percentile":1217.87,"90th_percentile":2317.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1299.05,"10th_percentile":1299.05,"90th_percentile":1299.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 3 Lower GI Procedures","code_information":[{"code":"5313","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 33.9] [Cardiac Cath (%BC): 33.9] [Observation (%BC): 57.7] [Emergency Department (%BC): 57.7] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 33.9] [Occupational Therapy (%BC): 33.9] [Physical Therapy (%BC): 33.9] [Respiratory Services/Therapy  (%BC): 33.9] [Speech Therapy (%BC): 33.9] [All Other OP (%BC): 33.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Avmed","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Baycare Plus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 30.92] [Cardiac Cath (%BC): 30.92] [Lithotripsy (%BC): 30.92] [PTCA (%BC): 30.92] [Observation (%BC): 47.84] [Emergency Department (%BC): 47.84] [Other Cardiac Testing (%BC): 41.01] [EEG (%BC): 41.01] [Chemotherapy (%BC): 41.01] [Nuclear Medicine (%BC): 15.94] [Radiation Therapy  (%BC): 41.01] [CT OP Scan (%BC): 15.94] [MRI OP (%BC): 15.94] [Positron Emission Tomography (%BC): 15.94] [Radiology (%BC): 15.94] [Laboratory (%BC): 41.01] [Occupational Therapy (%BC): 41.01] [Physical Therapy (%BC): 41.01] [Speech Therapy (%BC): 41.01] [Other Outpatient Implant (%BC): 24.52] [IV Therapy (%BC): 41.01] [All Other OP (%BC): 41.01]","count":"1 through 10","median_amount":15304.31,"10th_percentile":15304.31,"90th_percentile":15304.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50] [All Other OP (%BC): 16.218]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 45.89] [Cardiac Cath (%BC): 45.89] [Lithotripsy (%BC): 45.89] [PTCA (%BC): 45.89] [Observation (%BC): 55.14] [Emergency Department (%BC): 55.14] [Other Cardiac Testing (%BC): 50.30] [EEG (%BC): 50.30] [Chemotherapy (%BC): 50.30] [Nuclear Medicine (%BC): 18.93] [Radiation Therapy  (%BC): 50.30] [CT OP Scan (%BC): 18.93] [MRI OP (%BC): 18.93] [Positron Emission Tomography (%BC): 18.93] [Radiology (%BC): 18.93] [Laboratory (%BC): 50.30] [Occupational Therapy (%BC): 50.30] [Physical Therapy (%BC): 50.30] [Speech Therapy (%BC): 50.30] [Other Outpatient Implant (%BC): 24.52] [IV Therapy (%BC): 50.30] [All Other OP (%BC): 50.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 27.6] [Cardiac Cath (%BC): 27.6] [Observation (%BC): 42.8] [Emergency Department (%BC): 42.8] [Occupational Therapy (%BC): 27.6] [Physical Therapy (%BC): 27.6] [Respiratory Services/Therapy  (%BC): 27.6] [Speech Therapy (%BC): 27.6] [All Other OP (%BC): 27.6]","count":"1 through 10","median_amount":9812.55,"10th_percentile":9812.55,"90th_percentile":9812.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"First Health/Coventry","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":275.0,"10th_percentile":275.0,"90th_percentile":275.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 60.4] [Cardiac Cath (%BC): 60.4] [Observation (%BC): 53.7] [Emergency Department (%BC): 53.7] [Occupational Therapy (%BC): 60.4] [Physical Therapy (%BC): 60.4] [Respiratory Services/Therapy  (%BC): 60.4] [Speech Therapy (%BC): 60.4] [All Other OP (%BC): 60.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Abdominal/Peritoneal/Biliary and Related Procedures","code_information":[{"code":"5341","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 33.9] [Cardiac Cath (%BC): 33.9] [Observation (%BC): 57.7] [Emergency Department (%BC): 57.7] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 33.9] [Occupational Therapy (%BC): 33.9] [Physical Therapy (%BC): 33.9] [Respiratory Services/Therapy  (%BC): 33.9] [Speech Therapy (%BC): 33.9] [All Other OP (%BC): 33.9]","count":"1 through 10","median_amount":233.56,"10th_percentile":233.56,"90th_percentile":233.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Avmed","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Baycare Plus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 30.92] [Cardiac Cath (%BC): 30.92] [Lithotripsy (%BC): 30.92] [PTCA (%BC): 30.92] [Observation (%BC): 47.84] [Emergency Department (%BC): 47.84] [Other Cardiac Testing (%BC): 41.01] [EEG (%BC): 41.01] [Chemotherapy (%BC): 41.01] [Nuclear Medicine (%BC): 15.94] [Radiation Therapy  (%BC): 41.01] [CT OP Scan (%BC): 15.94] [MRI OP (%BC): 15.94] [Positron Emission Tomography (%BC): 15.94] [Radiology (%BC): 15.94] [Laboratory (%BC): 41.01] [Occupational Therapy (%BC): 41.01] [Physical Therapy (%BC): 41.01] [Speech Therapy (%BC): 41.01] [Other Outpatient Implant (%BC): 24.52] [IV Therapy (%BC): 41.01] [All Other OP (%BC): 41.01]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50] [All Other OP (%BC): 16.218]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 45.89] [Cardiac Cath (%BC): 45.89] [Lithotripsy (%BC): 45.89] [PTCA (%BC): 45.89] [Observation (%BC): 55.14] [Emergency Department (%BC): 55.14] [Other Cardiac Testing (%BC): 50.30] [EEG (%BC): 50.30] [Chemotherapy (%BC): 50.30] [Nuclear Medicine (%BC): 18.93] [Radiation Therapy  (%BC): 50.30] [CT OP Scan (%BC): 18.93] [MRI OP (%BC): 18.93] [Positron Emission Tomography (%BC): 18.93] [Radiology (%BC): 18.93] [Laboratory (%BC): 50.30] [Occupational Therapy (%BC): 50.30] [Physical Therapy (%BC): 50.30] [Speech Therapy (%BC): 50.30] [Other Outpatient Implant (%BC): 24.52] [IV Therapy (%BC): 50.30] [All Other OP (%BC): 50.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3507.48,"10th_percentile":3507.48,"90th_percentile":3507.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 27.6] [Cardiac Cath (%BC): 27.6] [Observation (%BC): 42.8] [Emergency Department (%BC): 42.8] [Occupational Therapy (%BC): 27.6] [Physical Therapy (%BC): 27.6] [Respiratory Services/Therapy  (%BC): 27.6] [Speech Therapy (%BC): 27.6] [All Other OP (%BC): 27.6]","count":"1 through 10","median_amount":16228.61,"10th_percentile":16228.61,"90th_percentile":16228.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"First Health/Coventry","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 60.4] [Cardiac Cath (%BC): 60.4] [Observation (%BC): 53.7] [Emergency Department (%BC): 53.7] [Occupational Therapy (%BC): 60.4] [Physical Therapy (%BC): 60.4] [Respiratory Services/Therapy  (%BC): 60.4] [Speech Therapy (%BC): 60.4] [All Other OP (%BC): 60.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Abdominal/Peritoneal/Biliary and Related Procedures","code_information":[{"code":"5342","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 33.9] [Cardiac Cath (%BC): 33.9] [Observation (%BC): 57.7] [Emergency Department (%BC): 57.7] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 33.9] [Occupational Therapy (%BC): 33.9] [Physical Therapy (%BC): 33.9] [Respiratory Services/Therapy  (%BC): 33.9] [Speech Therapy (%BC): 33.9] [All Other OP (%BC): 33.9]","count":"1 through 10","median_amount":9278.87,"10th_percentile":9278.87,"90th_percentile":9278.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Avmed","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Baycare Plus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 30.92] [Cardiac Cath (%BC): 30.92] [Lithotripsy (%BC): 30.92] [PTCA (%BC): 30.92] [Observation (%BC): 47.84] [Emergency Department (%BC): 47.84] [Other Cardiac Testing (%BC): 41.01] [EEG (%BC): 41.01] [Chemotherapy (%BC): 41.01] [Nuclear Medicine (%BC): 15.94] [Radiation Therapy  (%BC): 41.01] [CT OP Scan (%BC): 15.94] [MRI OP (%BC): 15.94] [Positron Emission Tomography (%BC): 15.94] [Radiology (%BC): 15.94] [Laboratory (%BC): 41.01] [Occupational Therapy (%BC): 41.01] [Physical Therapy (%BC): 41.01] [Speech Therapy (%BC): 41.01] [Other Outpatient Implant (%BC): 24.52] [IV Therapy (%BC): 41.01] [All Other OP (%BC): 41.01]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50] [All Other OP (%BC): 16.218]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 45.89] [Cardiac Cath (%BC): 45.89] [Lithotripsy (%BC): 45.89] [PTCA (%BC): 45.89] [Observation (%BC): 55.14] [Emergency Department (%BC): 55.14] [Other Cardiac Testing (%BC): 50.30] [EEG (%BC): 50.30] [Chemotherapy (%BC): 50.30] [Nuclear Medicine (%BC): 18.93] [Radiation Therapy  (%BC): 50.30] [CT OP Scan (%BC): 18.93] [MRI OP (%BC): 18.93] [Positron Emission Tomography (%BC): 18.93] [Radiology (%BC): 18.93] [Laboratory (%BC): 50.30] [Occupational Therapy (%BC): 50.30] [Physical Therapy (%BC): 50.30] [Speech Therapy (%BC): 50.30] [Other Outpatient Implant (%BC): 24.52] [IV Therapy (%BC): 50.30] [All Other OP (%BC): 50.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 27.6] [Cardiac Cath (%BC): 27.6] [Observation (%BC): 42.8] [Emergency Department (%BC): 42.8] [Occupational Therapy (%BC): 27.6] [Physical Therapy (%BC): 27.6] [Respiratory Services/Therapy  (%BC): 27.6] [Speech Therapy (%BC): 27.6] [All Other OP (%BC): 27.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":2673.66,"10th_percentile":2673.66,"90th_percentile":2673.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 60.4] [Cardiac Cath (%BC): 60.4] [Observation (%BC): 53.7] [Emergency Department (%BC): 53.7] [Occupational Therapy (%BC): 60.4] [Physical Therapy (%BC): 60.4] [Respiratory Services/Therapy  (%BC): 60.4] [Speech Therapy (%BC): 60.4] [All Other OP (%BC): 60.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Laparoscopy and Related Services","code_information":[{"code":"5361","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 33.9] [Cardiac Cath (%BC): 33.9] [Observation (%BC): 57.7] [Emergency Department (%BC): 57.7] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 33.9] [Occupational Therapy (%BC): 33.9] [Physical Therapy (%BC): 33.9] [Respiratory Services/Therapy  (%BC): 33.9] [Speech Therapy (%BC): 33.9] [All Other OP (%BC): 33.9]","count":"1 through 10","median_amount":15818.26,"10th_percentile":4460.42,"90th_percentile":31358.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":5977.5,"10th_percentile":5977.5,"90th_percentile":5977.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Avmed","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Baycare Plus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 30.92] [Cardiac Cath (%BC): 30.92] [Lithotripsy (%BC): 30.92] [PTCA (%BC): 30.92] [Observation (%BC): 47.84] [Emergency Department (%BC): 47.84] [Other Cardiac Testing (%BC): 41.01] [EEG (%BC): 41.01] [Chemotherapy (%BC): 41.01] [Nuclear Medicine (%BC): 15.94] [Radiation Therapy  (%BC): 41.01] [CT OP Scan (%BC): 15.94] [MRI OP (%BC): 15.94] [Positron Emission Tomography (%BC): 15.94] [Radiology (%BC): 15.94] [Laboratory (%BC): 41.01] [Occupational Therapy (%BC): 41.01] [Physical Therapy (%BC): 41.01] [Speech Therapy (%BC): 41.01] [Other Outpatient Implant (%BC): 24.52] [IV Therapy (%BC): 41.01] [All Other OP (%BC): 41.01]","count":"1 through 10","median_amount":24979.18,"10th_percentile":16241.06,"90th_percentile":36008.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50] [All Other OP (%BC): 16.218]","count":"1 through 10","median_amount":5973.54,"10th_percentile":5973.54,"90th_percentile":5973.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 45.89] [Cardiac Cath (%BC): 45.89] [Lithotripsy (%BC): 45.89] [PTCA (%BC): 45.89] [Observation (%BC): 55.14] [Emergency Department (%BC): 55.14] [Other Cardiac Testing (%BC): 50.30] [EEG (%BC): 50.30] [Chemotherapy (%BC): 50.30] [Nuclear Medicine (%BC): 18.93] [Radiation Therapy  (%BC): 50.30] [CT OP Scan (%BC): 18.93] [MRI OP (%BC): 18.93] [Positron Emission Tomography (%BC): 18.93] [Radiology (%BC): 18.93] [Laboratory (%BC): 50.30] [Occupational Therapy (%BC): 50.30] [Physical Therapy (%BC): 50.30] [Speech Therapy (%BC): 50.30] [Other Outpatient Implant (%BC): 24.52] [IV Therapy (%BC): 50.30] [All Other OP (%BC): 50.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":5805.63,"10th_percentile":5805.63,"90th_percentile":5805.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 27.6] [Cardiac Cath (%BC): 27.6] [Observation (%BC): 42.8] [Emergency Department (%BC): 42.8] [Occupational Therapy (%BC): 27.6] [Physical Therapy (%BC): 27.6] [Respiratory Services/Therapy  (%BC): 27.6] [Speech Therapy (%BC): 27.6] [All Other OP (%BC): 27.6]","count":"1 through 10","median_amount":22864.39,"10th_percentile":21240.47,"90th_percentile":29173.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"First Health/Coventry","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":13658.59,"10th_percentile":10694.91,"90th_percentile":21009.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":2521.18,"10th_percentile":2521.18,"90th_percentile":2521.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":13002.58,"10th_percentile":13002.58,"90th_percentile":16336.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":3000.04,"10th_percentile":3000.04,"90th_percentile":3000.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 60.4] [Cardiac Cath (%BC): 60.4] [Observation (%BC): 53.7] [Emergency Department (%BC): 53.7] [Occupational Therapy (%BC): 60.4] [Physical Therapy (%BC): 60.4] [Respiratory Services/Therapy  (%BC): 60.4] [Speech Therapy (%BC): 60.4] [All Other OP (%BC): 60.4]","count":"1 through 10","median_amount":50610.13,"10th_percentile":50610.13,"90th_percentile":76159.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":6050.84,"10th_percentile":6046.8,"90th_percentile":6058.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":6437.0,"10th_percentile":6437.0,"90th_percentile":6437.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 2 Laparoscopy and Related Services","code_information":[{"code":"5362","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 33.9] [Cardiac Cath (%BC): 33.9] [Observation (%BC): 57.7] [Emergency Department (%BC): 57.7] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 33.9] [Occupational Therapy (%BC): 33.9] [Physical Therapy (%BC): 33.9] [Respiratory Services/Therapy  (%BC): 33.9] [Speech Therapy (%BC): 33.9] [All Other OP (%BC): 33.9]","count":"1 through 10","median_amount":31472.65,"10th_percentile":31472.65,"90th_percentile":31472.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":17301.45,"10th_percentile":17301.45,"90th_percentile":17301.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Avmed","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Baycare Plus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 30.92] [Cardiac Cath (%BC): 30.92] [Lithotripsy (%BC): 30.92] [PTCA (%BC): 30.92] [Observation (%BC): 47.84] [Emergency Department (%BC): 47.84] [Other Cardiac Testing (%BC): 41.01] [EEG (%BC): 41.01] [Chemotherapy (%BC): 41.01] [Nuclear Medicine (%BC): 15.94] [Radiation Therapy  (%BC): 41.01] [CT OP Scan (%BC): 15.94] [MRI OP (%BC): 15.94] [Positron Emission Tomography (%BC): 15.94] [Radiology (%BC): 15.94] [Laboratory (%BC): 41.01] [Occupational Therapy (%BC): 41.01] [Physical Therapy (%BC): 41.01] [Speech Therapy (%BC): 41.01] [Other Outpatient Implant (%BC): 24.52] [IV Therapy (%BC): 41.01] [All Other OP (%BC): 41.01]","count":"1 through 10","median_amount":52761.35,"10th_percentile":52761.35,"90th_percentile":52761.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50] [All Other OP (%BC): 16.218]","count":"1 through 10","median_amount":10659.58,"10th_percentile":10659.58,"90th_percentile":10659.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 45.89] [Cardiac Cath (%BC): 45.89] [Lithotripsy (%BC): 45.89] [PTCA (%BC): 45.89] [Observation (%BC): 55.14] [Emergency Department (%BC): 55.14] [Other Cardiac Testing (%BC): 50.30] [EEG (%BC): 50.30] [Chemotherapy (%BC): 50.30] [Nuclear Medicine (%BC): 18.93] [Radiation Therapy  (%BC): 50.30] [CT OP Scan (%BC): 18.93] [MRI OP (%BC): 18.93] [Positron Emission Tomography (%BC): 18.93] [Radiology (%BC): 18.93] [Laboratory (%BC): 50.30] [Occupational Therapy (%BC): 50.30] [Physical Therapy (%BC): 50.30] [Speech Therapy (%BC): 50.30] [Other Outpatient Implant (%BC): 24.52] [IV Therapy (%BC): 50.30] [All Other OP (%BC): 50.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 27.6] [Cardiac Cath (%BC): 27.6] [Observation (%BC): 42.8] [Emergency Department (%BC): 42.8] [Occupational Therapy (%BC): 27.6] [Physical Therapy (%BC): 27.6] [Respiratory Services/Therapy  (%BC): 27.6] [Speech Therapy (%BC): 27.6] [All Other OP (%BC): 27.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":24.17,"10th_percentile":24.17,"90th_percentile":23266.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 60.4] [Cardiac Cath (%BC): 60.4] [Observation (%BC): 53.7] [Emergency Department (%BC): 53.7] [Occupational Therapy (%BC): 60.4] [Physical Therapy (%BC): 60.4] [Respiratory Services/Therapy  (%BC): 60.4] [Speech Therapy (%BC): 60.4] [All Other OP (%BC): 60.4]","count":"1 through 10","median_amount":39868.51,"10th_percentile":39868.51,"90th_percentile":39868.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Urology and Related Services","code_information":[{"code":"5371","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 33.9] [Cardiac Cath (%BC): 33.9] [Observation (%BC): 57.7] [Emergency Department (%BC): 57.7] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 33.9] [Occupational Therapy (%BC): 33.9] [Physical Therapy (%BC): 33.9] [Respiratory Services/Therapy  (%BC): 33.9] [Speech Therapy (%BC): 33.9] [All Other OP (%BC): 33.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Avmed","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Baycare Plus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 30.92] [Cardiac Cath (%BC): 30.92] [Lithotripsy (%BC): 30.92] [PTCA (%BC): 30.92] [Observation (%BC): 47.84] [Emergency Department (%BC): 47.84] [Other Cardiac Testing (%BC): 41.01] [EEG (%BC): 41.01] [Chemotherapy (%BC): 41.01] [Nuclear Medicine (%BC): 15.94] [Radiation Therapy  (%BC): 41.01] [CT OP Scan (%BC): 15.94] [MRI OP (%BC): 15.94] [Positron Emission Tomography (%BC): 15.94] [Radiology (%BC): 15.94] [Laboratory (%BC): 41.01] [Occupational Therapy (%BC): 41.01] [Physical Therapy (%BC): 41.01] [Speech Therapy (%BC): 41.01] [Other Outpatient Implant (%BC): 24.52] [IV Therapy (%BC): 41.01] [All Other OP (%BC): 41.01]","count":"1 through 10","median_amount":9181.88,"10th_percentile":9181.88,"90th_percentile":9181.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50] [All Other OP (%BC): 16.218]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 45.89] [Cardiac Cath (%BC): 45.89] [Lithotripsy (%BC): 45.89] [PTCA (%BC): 45.89] [Observation (%BC): 55.14] [Emergency Department (%BC): 55.14] [Other Cardiac Testing (%BC): 50.30] [EEG (%BC): 50.30] [Chemotherapy (%BC): 50.30] [Nuclear Medicine (%BC): 18.93] [Radiation Therapy  (%BC): 50.30] [CT OP Scan (%BC): 18.93] [MRI OP (%BC): 18.93] [Positron Emission Tomography (%BC): 18.93] [Radiology (%BC): 18.93] [Laboratory (%BC): 50.30] [Occupational Therapy (%BC): 50.30] [Physical Therapy (%BC): 50.30] [Speech Therapy (%BC): 50.30] [Other Outpatient Implant (%BC): 24.52] [IV Therapy (%BC): 50.30] [All Other OP (%BC): 50.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 27.6] [Cardiac Cath (%BC): 27.6] [Observation (%BC): 42.8] [Emergency Department (%BC): 42.8] [Occupational Therapy (%BC): 27.6] [Physical Therapy (%BC): 27.6] [Respiratory Services/Therapy  (%BC): 27.6] [Speech Therapy (%BC): 27.6] [All Other OP (%BC): 27.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 60.4] [Cardiac Cath (%BC): 60.4] [Observation (%BC): 53.7] [Emergency Department (%BC): 53.7] [Occupational Therapy (%BC): 60.4] [Physical Therapy (%BC): 60.4] [Respiratory Services/Therapy  (%BC): 60.4] [Speech Therapy (%BC): 60.4] [All Other OP (%BC): 60.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 3 Urology and Related Services","code_information":[{"code":"5373","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 33.9] [Cardiac Cath (%BC): 33.9] [Observation (%BC): 57.7] [Emergency Department (%BC): 57.7] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 33.9] [Occupational Therapy (%BC): 33.9] [Physical Therapy (%BC): 33.9] [Respiratory Services/Therapy  (%BC): 33.9] [Speech Therapy (%BC): 33.9] [All Other OP (%BC): 33.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2101.63,"10th_percentile":2101.63,"90th_percentile":2101.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Avmed","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Baycare Plus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 30.92] [Cardiac Cath (%BC): 30.92] [Lithotripsy (%BC): 30.92] [PTCA (%BC): 30.92] [Observation (%BC): 47.84] [Emergency Department (%BC): 47.84] [Other Cardiac Testing (%BC): 41.01] [EEG (%BC): 41.01] [Chemotherapy (%BC): 41.01] [Nuclear Medicine (%BC): 15.94] [Radiation Therapy  (%BC): 41.01] [CT OP Scan (%BC): 15.94] [MRI OP (%BC): 15.94] [Positron Emission Tomography (%BC): 15.94] [Radiology (%BC): 15.94] [Laboratory (%BC): 41.01] [Occupational Therapy (%BC): 41.01] [Physical Therapy (%BC): 41.01] [Speech Therapy (%BC): 41.01] [Other Outpatient Implant (%BC): 24.52] [IV Therapy (%BC): 41.01] [All Other OP (%BC): 41.01]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50] [All Other OP (%BC): 16.218]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 45.89] [Cardiac Cath (%BC): 45.89] [Lithotripsy (%BC): 45.89] [PTCA (%BC): 45.89] [Observation (%BC): 55.14] [Emergency Department (%BC): 55.14] [Other Cardiac Testing (%BC): 50.30] [EEG (%BC): 50.30] [Chemotherapy (%BC): 50.30] [Nuclear Medicine (%BC): 18.93] [Radiation Therapy  (%BC): 50.30] [CT OP Scan (%BC): 18.93] [MRI OP (%BC): 18.93] [Positron Emission Tomography (%BC): 18.93] [Radiology (%BC): 18.93] [Laboratory (%BC): 50.30] [Occupational Therapy (%BC): 50.30] [Physical Therapy (%BC): 50.30] [Speech Therapy (%BC): 50.30] [Other Outpatient Implant (%BC): 24.52] [IV Therapy (%BC): 50.30] [All Other OP (%BC): 50.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 27.6] [Cardiac Cath (%BC): 27.6] [Observation (%BC): 42.8] [Emergency Department (%BC): 42.8] [Occupational Therapy (%BC): 27.6] [Physical Therapy (%BC): 27.6] [Respiratory Services/Therapy  (%BC): 27.6] [Speech Therapy (%BC): 27.6] [All Other OP (%BC): 27.6]","count":"1 through 10","median_amount":10581.57,"10th_percentile":10581.57,"90th_percentile":10581.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"First Health/Coventry","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2015.12,"10th_percentile":2015.12,"90th_percentile":2015.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3755.82,"10th_percentile":3755.82,"90th_percentile":3755.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":1073.59,"10th_percentile":1073.59,"90th_percentile":1073.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":4564.88,"10th_percentile":4564.88,"90th_percentile":4564.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 60.4] [Cardiac Cath (%BC): 60.4] [Observation (%BC): 53.7] [Emergency Department (%BC): 53.7] [Occupational Therapy (%BC): 60.4] [Physical Therapy (%BC): 60.4] [Respiratory Services/Therapy  (%BC): 60.4] [Speech Therapy (%BC): 60.4] [All Other OP (%BC): 60.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 4 Urology and Related Services","code_information":[{"code":"5374","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 33.9] [Cardiac Cath (%BC): 33.9] [Observation (%BC): 57.7] [Emergency Department (%BC): 57.7] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 33.9] [Occupational Therapy (%BC): 33.9] [Physical Therapy (%BC): 33.9] [Respiratory Services/Therapy  (%BC): 33.9] [Speech Therapy (%BC): 33.9] [All Other OP (%BC): 33.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Avmed","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Baycare Plus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 30.92] [Cardiac Cath (%BC): 30.92] [Lithotripsy (%BC): 30.92] [PTCA (%BC): 30.92] [Observation (%BC): 47.84] [Emergency Department (%BC): 47.84] [Other Cardiac Testing (%BC): 41.01] [EEG (%BC): 41.01] [Chemotherapy (%BC): 41.01] [Nuclear Medicine (%BC): 15.94] [Radiation Therapy  (%BC): 41.01] [CT OP Scan (%BC): 15.94] [MRI OP (%BC): 15.94] [Positron Emission Tomography (%BC): 15.94] [Radiology (%BC): 15.94] [Laboratory (%BC): 41.01] [Occupational Therapy (%BC): 41.01] [Physical Therapy (%BC): 41.01] [Speech Therapy (%BC): 41.01] [Other Outpatient Implant (%BC): 24.52] [IV Therapy (%BC): 41.01] [All Other OP (%BC): 41.01]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50] [All Other OP (%BC): 16.218]","count":"1 through 10","median_amount":3532.86,"10th_percentile":3532.86,"90th_percentile":3532.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 45.89] [Cardiac Cath (%BC): 45.89] [Lithotripsy (%BC): 45.89] [PTCA (%BC): 45.89] [Observation (%BC): 55.14] [Emergency Department (%BC): 55.14] [Other Cardiac Testing (%BC): 50.30] [EEG (%BC): 50.30] [Chemotherapy (%BC): 50.30] [Nuclear Medicine (%BC): 18.93] [Radiation Therapy  (%BC): 50.30] [CT OP Scan (%BC): 18.93] [MRI OP (%BC): 18.93] [Positron Emission Tomography (%BC): 18.93] [Radiology (%BC): 18.93] [Laboratory (%BC): 50.30] [Occupational Therapy (%BC): 50.30] [Physical Therapy (%BC): 50.30] [Speech Therapy (%BC): 50.30] [Other Outpatient Implant (%BC): 24.52] [IV Therapy (%BC): 50.30] [All Other OP (%BC): 50.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 27.6] [Cardiac Cath (%BC): 27.6] [Observation (%BC): 42.8] [Emergency Department (%BC): 42.8] [Occupational Therapy (%BC): 27.6] [Physical Therapy (%BC): 27.6] [Respiratory Services/Therapy  (%BC): 27.6] [Speech Therapy (%BC): 27.6] [All Other OP (%BC): 27.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3406.37,"10th_percentile":3406.37,"90th_percentile":3406.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 60.4] [Cardiac Cath (%BC): 60.4] [Observation (%BC): 53.7] [Emergency Department (%BC): 53.7] [Occupational Therapy (%BC): 60.4] [Physical Therapy (%BC): 60.4] [Respiratory Services/Therapy  (%BC): 60.4] [Speech Therapy (%BC): 60.4] [All Other OP (%BC): 60.4]","count":"1 through 10","median_amount":28569.01,"10th_percentile":28569.01,"90th_percentile":28569.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 5 Urology and Related Services","code_information":[{"code":"5375","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 33.9] [Cardiac Cath (%BC): 33.9] [Observation (%BC): 57.7] [Emergency Department (%BC): 57.7] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 33.9] [Occupational Therapy (%BC): 33.9] [Physical Therapy (%BC): 33.9] [Respiratory Services/Therapy  (%BC): 33.9] [Speech Therapy (%BC): 33.9] [All Other OP (%BC): 33.9]","count":"1 through 10","median_amount":17833.75,"10th_percentile":17833.75,"90th_percentile":17833.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Avmed","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Baycare Plus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 30.92] [Cardiac Cath (%BC): 30.92] [Lithotripsy (%BC): 30.92] [PTCA (%BC): 30.92] [Observation (%BC): 47.84] [Emergency Department (%BC): 47.84] [Other Cardiac Testing (%BC): 41.01] [EEG (%BC): 41.01] [Chemotherapy (%BC): 41.01] [Nuclear Medicine (%BC): 15.94] [Radiation Therapy  (%BC): 41.01] [CT OP Scan (%BC): 15.94] [MRI OP (%BC): 15.94] [Positron Emission Tomography (%BC): 15.94] [Radiology (%BC): 15.94] [Laboratory (%BC): 41.01] [Occupational Therapy (%BC): 41.01] [Physical Therapy (%BC): 41.01] [Speech Therapy (%BC): 41.01] [Other Outpatient Implant (%BC): 24.52] [IV Therapy (%BC): 41.01] [All Other OP (%BC): 41.01]","count":"1 through 10","median_amount":17861.06,"10th_percentile":17861.06,"90th_percentile":17861.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50] [All Other OP (%BC): 16.218]","count":"1 through 10","median_amount":5212.92,"10th_percentile":5212.92,"90th_percentile":5212.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 45.89] [Cardiac Cath (%BC): 45.89] [Lithotripsy (%BC): 45.89] [PTCA (%BC): 45.89] [Observation (%BC): 55.14] [Emergency Department (%BC): 55.14] [Other Cardiac Testing (%BC): 50.30] [EEG (%BC): 50.30] [Chemotherapy (%BC): 50.30] [Nuclear Medicine (%BC): 18.93] [Radiation Therapy  (%BC): 50.30] [CT OP Scan (%BC): 18.93] [MRI OP (%BC): 18.93] [Positron Emission Tomography (%BC): 18.93] [Radiology (%BC): 18.93] [Laboratory (%BC): 50.30] [Occupational Therapy (%BC): 50.30] [Physical Therapy (%BC): 50.30] [Speech Therapy (%BC): 50.30] [Other Outpatient Implant (%BC): 24.52] [IV Therapy (%BC): 50.30] [All Other OP (%BC): 50.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 27.6] [Cardiac Cath (%BC): 27.6] [Observation (%BC): 42.8] [Emergency Department (%BC): 42.8] [Occupational Therapy (%BC): 27.6] [Physical Therapy (%BC): 27.6] [Respiratory Services/Therapy  (%BC): 27.6] [Speech Therapy (%BC): 27.6] [All Other OP (%BC): 27.6]","count":"1 through 10","median_amount":15451.14,"10th_percentile":15451.14,"90th_percentile":15451.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"First Health/Coventry","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":11330.99,"10th_percentile":11330.99,"90th_percentile":11330.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 60.4] [Cardiac Cath (%BC): 60.4] [Observation (%BC): 53.7] [Emergency Department (%BC): 53.7] [Occupational Therapy (%BC): 60.4] [Physical Therapy (%BC): 60.4] [Respiratory Services/Therapy  (%BC): 60.4] [Speech Therapy (%BC): 60.4] [All Other OP (%BC): 60.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 6 Urology and Related Services","code_information":[{"code":"5376","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 33.9] [Cardiac Cath (%BC): 33.9] [Observation (%BC): 57.7] [Emergency Department (%BC): 57.7] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 33.9] [Occupational Therapy (%BC): 33.9] [Physical Therapy (%BC): 33.9] [Respiratory Services/Therapy  (%BC): 33.9] [Speech Therapy (%BC): 33.9] [All Other OP (%BC): 33.9]","count":"1 through 10","median_amount":21.7,"10th_percentile":21.7,"90th_percentile":21.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Avmed","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Baycare Plus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 30.92] [Cardiac Cath (%BC): 30.92] [Lithotripsy (%BC): 30.92] [PTCA (%BC): 30.92] [Observation (%BC): 47.84] [Emergency Department (%BC): 47.84] [Other Cardiac Testing (%BC): 41.01] [EEG (%BC): 41.01] [Chemotherapy (%BC): 41.01] [Nuclear Medicine (%BC): 15.94] [Radiation Therapy  (%BC): 41.01] [CT OP Scan (%BC): 15.94] [MRI OP (%BC): 15.94] [Positron Emission Tomography (%BC): 15.94] [Radiology (%BC): 15.94] [Laboratory (%BC): 41.01] [Occupational Therapy (%BC): 41.01] [Physical Therapy (%BC): 41.01] [Speech Therapy (%BC): 41.01] [Other Outpatient Implant (%BC): 24.52] [IV Therapy (%BC): 41.01] [All Other OP (%BC): 41.01]","count":"1 through 10","median_amount":39084.28,"10th_percentile":39084.28,"90th_percentile":39084.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50] [All Other OP (%BC): 16.218]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 45.89] [Cardiac Cath (%BC): 45.89] [Lithotripsy (%BC): 45.89] [PTCA (%BC): 45.89] [Observation (%BC): 55.14] [Emergency Department (%BC): 55.14] [Other Cardiac Testing (%BC): 50.30] [EEG (%BC): 50.30] [Chemotherapy (%BC): 50.30] [Nuclear Medicine (%BC): 18.93] [Radiation Therapy  (%BC): 50.30] [CT OP Scan (%BC): 18.93] [MRI OP (%BC): 18.93] [Positron Emission Tomography (%BC): 18.93] [Radiology (%BC): 18.93] [Laboratory (%BC): 50.30] [Occupational Therapy (%BC): 50.30] [Physical Therapy (%BC): 50.30] [Speech Therapy (%BC): 50.30] [Other Outpatient Implant (%BC): 24.52] [IV Therapy (%BC): 50.30] [All Other OP (%BC): 50.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":10756.16,"10th_percentile":10756.16,"90th_percentile":10756.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 27.6] [Cardiac Cath (%BC): 27.6] [Observation (%BC): 42.8] [Emergency Department (%BC): 42.8] [Occupational Therapy (%BC): 27.6] [Physical Therapy (%BC): 27.6] [Respiratory Services/Therapy  (%BC): 27.6] [Speech Therapy (%BC): 27.6] [All Other OP (%BC): 27.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":16949.11,"10th_percentile":16949.11,"90th_percentile":16963.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":3468.41,"10th_percentile":3468.41,"90th_percentile":3468.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":9646.98,"10th_percentile":9646.98,"90th_percentile":9646.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 60.4] [Cardiac Cath (%BC): 60.4] [Observation (%BC): 53.7] [Emergency Department (%BC): 53.7] [Occupational Therapy (%BC): 60.4] [Physical Therapy (%BC): 60.4] [Respiratory Services/Therapy  (%BC): 60.4] [Speech Therapy (%BC): 60.4] [All Other OP (%BC): 60.4]","count":"1 through 10","median_amount":56115.9,"10th_percentile":56115.9,"90th_percentile":56115.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":9598.53,"10th_percentile":9598.53,"90th_percentile":9598.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Gynecologic Procedures","code_information":[{"code":"5411","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 33.9] [Cardiac Cath (%BC): 33.9] [Observation (%BC): 57.7] [Emergency Department (%BC): 57.7] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 33.9] [Occupational Therapy (%BC): 33.9] [Physical Therapy (%BC): 33.9] [Respiratory Services/Therapy  (%BC): 33.9] [Speech Therapy (%BC): 33.9] [All Other OP (%BC): 33.9]","count":"1 through 10","median_amount":385.92,"10th_percentile":385.92,"90th_percentile":385.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Avmed","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Baycare Plus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 30.92] [Cardiac Cath (%BC): 30.92] [Lithotripsy (%BC): 30.92] [PTCA (%BC): 30.92] [Observation (%BC): 47.84] [Emergency Department (%BC): 47.84] [Other Cardiac Testing (%BC): 41.01] [EEG (%BC): 41.01] [Chemotherapy (%BC): 41.01] [Nuclear Medicine (%BC): 15.94] [Radiation Therapy  (%BC): 41.01] [CT OP Scan (%BC): 15.94] [MRI OP (%BC): 15.94] [Positron Emission Tomography (%BC): 15.94] [Radiology (%BC): 15.94] [Laboratory (%BC): 41.01] [Occupational Therapy (%BC): 41.01] [Physical Therapy (%BC): 41.01] [Speech Therapy (%BC): 41.01] [Other Outpatient Implant (%BC): 24.52] [IV Therapy (%BC): 41.01] [All Other OP (%BC): 41.01]","count":"1 through 10","median_amount":1140.63,"10th_percentile":1140.63,"90th_percentile":1140.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50] [All Other OP (%BC): 16.218]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 45.89] [Cardiac Cath (%BC): 45.89] [Lithotripsy (%BC): 45.89] [PTCA (%BC): 45.89] [Observation (%BC): 55.14] [Emergency Department (%BC): 55.14] [Other Cardiac Testing (%BC): 50.30] [EEG (%BC): 50.30] [Chemotherapy (%BC): 50.30] [Nuclear Medicine (%BC): 18.93] [Radiation Therapy  (%BC): 50.30] [CT OP Scan (%BC): 18.93] [MRI OP (%BC): 18.93] [Positron Emission Tomography (%BC): 18.93] [Radiology (%BC): 18.93] [Laboratory (%BC): 50.30] [Occupational Therapy (%BC): 50.30] [Physical Therapy (%BC): 50.30] [Speech Therapy (%BC): 50.30] [Other Outpatient Implant (%BC): 24.52] [IV Therapy (%BC): 50.30] [All Other OP (%BC): 50.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 27.6] [Cardiac Cath (%BC): 27.6] [Observation (%BC): 42.8] [Emergency Department (%BC): 42.8] [Occupational Therapy (%BC): 27.6] [Physical Therapy (%BC): 27.6] [Respiratory Services/Therapy  (%BC): 27.6] [Speech Therapy (%BC): 27.6] [All Other OP (%BC): 27.6]","count":"1 through 10","median_amount":1081.3,"10th_percentile":1081.3,"90th_percentile":1081.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"First Health/Coventry","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":340.04,"10th_percentile":340.04,"90th_percentile":340.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":310.3,"10th_percentile":310.3,"90th_percentile":310.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":448.28,"10th_percentile":448.28,"90th_percentile":448.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":140.76,"10th_percentile":140.76,"90th_percentile":305.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 60.4] [Cardiac Cath (%BC): 60.4] [Observation (%BC): 53.7] [Emergency Department (%BC): 53.7] [Occupational Therapy (%BC): 60.4] [Physical Therapy (%BC): 60.4] [Respiratory Services/Therapy  (%BC): 60.4] [Speech Therapy (%BC): 60.4] [All Other OP (%BC): 60.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 4 Gynecologic Procedures","code_information":[{"code":"5414","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 33.9] [Cardiac Cath (%BC): 33.9] [Observation (%BC): 57.7] [Emergency Department (%BC): 57.7] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 33.9] [Occupational Therapy (%BC): 33.9] [Physical Therapy (%BC): 33.9] [Respiratory Services/Therapy  (%BC): 33.9] [Speech Therapy (%BC): 33.9] [All Other OP (%BC): 33.9]","count":"1 through 10","median_amount":16078.66,"10th_percentile":16078.66,"90th_percentile":16078.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Avmed","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Baycare Plus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 30.92] [Cardiac Cath (%BC): 30.92] [Lithotripsy (%BC): 30.92] [PTCA (%BC): 30.92] [Observation (%BC): 47.84] [Emergency Department (%BC): 47.84] [Other Cardiac Testing (%BC): 41.01] [EEG (%BC): 41.01] [Chemotherapy (%BC): 41.01] [Nuclear Medicine (%BC): 15.94] [Radiation Therapy  (%BC): 41.01] [CT OP Scan (%BC): 15.94] [MRI OP (%BC): 15.94] [Positron Emission Tomography (%BC): 15.94] [Radiology (%BC): 15.94] [Laboratory (%BC): 41.01] [Occupational Therapy (%BC): 41.01] [Physical Therapy (%BC): 41.01] [Speech Therapy (%BC): 41.01] [Other Outpatient Implant (%BC): 24.52] [IV Therapy (%BC): 41.01] [All Other OP (%BC): 41.01]","count":"1 through 10","median_amount":20190.36,"10th_percentile":15567.17,"90th_percentile":24063.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50] [All Other OP (%BC): 16.218]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 45.89] [Cardiac Cath (%BC): 45.89] [Lithotripsy (%BC): 45.89] [PTCA (%BC): 45.89] [Observation (%BC): 55.14] [Emergency Department (%BC): 55.14] [Other Cardiac Testing (%BC): 50.30] [EEG (%BC): 50.30] [Chemotherapy (%BC): 50.30] [Nuclear Medicine (%BC): 18.93] [Radiation Therapy  (%BC): 50.30] [CT OP Scan (%BC): 18.93] [MRI OP (%BC): 18.93] [Positron Emission Tomography (%BC): 18.93] [Radiology (%BC): 18.93] [Laboratory (%BC): 50.30] [Occupational Therapy (%BC): 50.30] [Physical Therapy (%BC): 50.30] [Speech Therapy (%BC): 50.30] [Other Outpatient Implant (%BC): 24.52] [IV Therapy (%BC): 50.30] [All Other OP (%BC): 50.30]","count":"1 through 10","median_amount":16240.64,"10th_percentile":16240.64,"90th_percentile":16240.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 27.6] [Cardiac Cath (%BC): 27.6] [Observation (%BC): 42.8] [Emergency Department (%BC): 42.8] [Occupational Therapy (%BC): 27.6] [Physical Therapy (%BC): 27.6] [Respiratory Services/Therapy  (%BC): 27.6] [Speech Therapy (%BC): 27.6] [All Other OP (%BC): 27.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":1517.81,"10th_percentile":1517.81,"90th_percentile":1517.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":7086.59,"10th_percentile":7086.59,"90th_percentile":7086.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":1642.6,"10th_percentile":1642.6,"90th_percentile":1642.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 60.4] [Cardiac Cath (%BC): 60.4] [Observation (%BC): 53.7] [Emergency Department (%BC): 53.7] [Occupational Therapy (%BC): 60.4] [Physical Therapy (%BC): 60.4] [Respiratory Services/Therapy  (%BC): 60.4] [Speech Therapy (%BC): 60.4] [All Other OP (%BC): 60.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 5 Gynecologic Procedures","code_information":[{"code":"5415","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 33.9] [Cardiac Cath (%BC): 33.9] [Observation (%BC): 57.7] [Emergency Department (%BC): 57.7] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 33.9] [Occupational Therapy (%BC): 33.9] [Physical Therapy (%BC): 33.9] [Respiratory Services/Therapy  (%BC): 33.9] [Speech Therapy (%BC): 33.9] [All Other OP (%BC): 33.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":291.34,"10th_percentile":291.34,"90th_percentile":291.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Avmed","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Baycare Plus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 30.92] [Cardiac Cath (%BC): 30.92] [Lithotripsy (%BC): 30.92] [PTCA (%BC): 30.92] [Observation (%BC): 47.84] [Emergency Department (%BC): 47.84] [Other Cardiac Testing (%BC): 41.01] [EEG (%BC): 41.01] [Chemotherapy (%BC): 41.01] [Nuclear Medicine (%BC): 15.94] [Radiation Therapy  (%BC): 41.01] [CT OP Scan (%BC): 15.94] [MRI OP (%BC): 15.94] [Positron Emission Tomography (%BC): 15.94] [Radiology (%BC): 15.94] [Laboratory (%BC): 41.01] [Occupational Therapy (%BC): 41.01] [Physical Therapy (%BC): 41.01] [Speech Therapy (%BC): 41.01] [Other Outpatient Implant (%BC): 24.52] [IV Therapy (%BC): 41.01] [All Other OP (%BC): 41.01]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50] [All Other OP (%BC): 16.218]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 45.89] [Cardiac Cath (%BC): 45.89] [Lithotripsy (%BC): 45.89] [PTCA (%BC): 45.89] [Observation (%BC): 55.14] [Emergency Department (%BC): 55.14] [Other Cardiac Testing (%BC): 50.30] [EEG (%BC): 50.30] [Chemotherapy (%BC): 50.30] [Nuclear Medicine (%BC): 18.93] [Radiation Therapy  (%BC): 50.30] [CT OP Scan (%BC): 18.93] [MRI OP (%BC): 18.93] [Positron Emission Tomography (%BC): 18.93] [Radiology (%BC): 18.93] [Laboratory (%BC): 50.30] [Occupational Therapy (%BC): 50.30] [Physical Therapy (%BC): 50.30] [Speech Therapy (%BC): 50.30] [Other Outpatient Implant (%BC): 24.52] [IV Therapy (%BC): 50.30] [All Other OP (%BC): 50.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 27.6] [Cardiac Cath (%BC): 27.6] [Observation (%BC): 42.8] [Emergency Department (%BC): 42.8] [Occupational Therapy (%BC): 27.6] [Physical Therapy (%BC): 27.6] [Respiratory Services/Therapy  (%BC): 27.6] [Speech Therapy (%BC): 27.6] [All Other OP (%BC): 27.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":1643.6,"10th_percentile":1643.6,"90th_percentile":1643.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":5152.63,"10th_percentile":5152.63,"90th_percentile":5152.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":11004.38,"10th_percentile":11001.69,"90th_percentile":11005.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 60.4] [Cardiac Cath (%BC): 60.4] [Observation (%BC): 53.7] [Emergency Department (%BC): 53.7] [Occupational Therapy (%BC): 60.4] [Physical Therapy (%BC): 60.4] [Respiratory Services/Therapy  (%BC): 60.4] [Speech Therapy (%BC): 60.4] [All Other OP (%BC): 60.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":5127.87,"10th_percentile":5127.87,"90th_percentile":5127.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 6 Gynecologic Procedures","code_information":[{"code":"5416","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 33.9] [Cardiac Cath (%BC): 33.9] [Observation (%BC): 57.7] [Emergency Department (%BC): 57.7] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 33.9] [Occupational Therapy (%BC): 33.9] [Physical Therapy (%BC): 33.9] [Respiratory Services/Therapy  (%BC): 33.9] [Speech Therapy (%BC): 33.9] [All Other OP (%BC): 33.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Avmed","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Baycare Plus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 30.92] [Cardiac Cath (%BC): 30.92] [Lithotripsy (%BC): 30.92] [PTCA (%BC): 30.92] [Observation (%BC): 47.84] [Emergency Department (%BC): 47.84] [Other Cardiac Testing (%BC): 41.01] [EEG (%BC): 41.01] [Chemotherapy (%BC): 41.01] [Nuclear Medicine (%BC): 15.94] [Radiation Therapy  (%BC): 41.01] [CT OP Scan (%BC): 15.94] [MRI OP (%BC): 15.94] [Positron Emission Tomography (%BC): 15.94] [Radiology (%BC): 15.94] [Laboratory (%BC): 41.01] [Occupational Therapy (%BC): 41.01] [Physical Therapy (%BC): 41.01] [Speech Therapy (%BC): 41.01] [Other Outpatient Implant (%BC): 24.52] [IV Therapy (%BC): 41.01] [All Other OP (%BC): 41.01]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50] [All Other OP (%BC): 16.218]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 45.89] [Cardiac Cath (%BC): 45.89] [Lithotripsy (%BC): 45.89] [PTCA (%BC): 45.89] [Observation (%BC): 55.14] [Emergency Department (%BC): 55.14] [Other Cardiac Testing (%BC): 50.30] [EEG (%BC): 50.30] [Chemotherapy (%BC): 50.30] [Nuclear Medicine (%BC): 18.93] [Radiation Therapy  (%BC): 50.30] [CT OP Scan (%BC): 18.93] [MRI OP (%BC): 18.93] [Positron Emission Tomography (%BC): 18.93] [Radiology (%BC): 18.93] [Laboratory (%BC): 50.30] [Occupational Therapy (%BC): 50.30] [Physical Therapy (%BC): 50.30] [Speech Therapy (%BC): 50.30] [Other Outpatient Implant (%BC): 24.52] [IV Therapy (%BC): 50.30] [All Other OP (%BC): 50.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 27.6] [Cardiac Cath (%BC): 27.6] [Observation (%BC): 42.8] [Emergency Department (%BC): 42.8] [Occupational Therapy (%BC): 27.6] [Physical Therapy (%BC): 27.6] [Respiratory Services/Therapy  (%BC): 27.6] [Speech Therapy (%BC): 27.6] [All Other OP (%BC): 27.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":16483.91,"10th_percentile":16483.91,"90th_percentile":16483.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 60.4] [Cardiac Cath (%BC): 60.4] [Observation (%BC): 53.7] [Emergency Department (%BC): 53.7] [Occupational Therapy (%BC): 60.4] [Physical Therapy (%BC): 60.4] [Respiratory Services/Therapy  (%BC): 60.4] [Speech Therapy (%BC): 60.4] [All Other OP (%BC): 60.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Nerve Procedures","code_information":[{"code":"5431","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 33.9] [Cardiac Cath (%BC): 33.9] [Observation (%BC): 57.7] [Emergency Department (%BC): 57.7] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 33.9] [Occupational Therapy (%BC): 33.9] [Physical Therapy (%BC): 33.9] [Respiratory Services/Therapy  (%BC): 33.9] [Speech Therapy (%BC): 33.9] [All Other OP (%BC): 33.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Avmed","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Baycare Plus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 30.92] [Cardiac Cath (%BC): 30.92] [Lithotripsy (%BC): 30.92] [PTCA (%BC): 30.92] [Observation (%BC): 47.84] [Emergency Department (%BC): 47.84] [Other Cardiac Testing (%BC): 41.01] [EEG (%BC): 41.01] [Chemotherapy (%BC): 41.01] [Nuclear Medicine (%BC): 15.94] [Radiation Therapy  (%BC): 41.01] [CT OP Scan (%BC): 15.94] [MRI OP (%BC): 15.94] [Positron Emission Tomography (%BC): 15.94] [Radiology (%BC): 15.94] [Laboratory (%BC): 41.01] [Occupational Therapy (%BC): 41.01] [Physical Therapy (%BC): 41.01] [Speech Therapy (%BC): 41.01] [Other Outpatient Implant (%BC): 24.52] [IV Therapy (%BC): 41.01] [All Other OP (%BC): 41.01]","count":"1 through 10","median_amount":40299.41,"10th_percentile":40299.41,"90th_percentile":40299.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50] [All Other OP (%BC): 16.218]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 45.89] [Cardiac Cath (%BC): 45.89] [Lithotripsy (%BC): 45.89] [PTCA (%BC): 45.89] [Observation (%BC): 55.14] [Emergency Department (%BC): 55.14] [Other Cardiac Testing (%BC): 50.30] [EEG (%BC): 50.30] [Chemotherapy (%BC): 50.30] [Nuclear Medicine (%BC): 18.93] [Radiation Therapy  (%BC): 50.30] [CT OP Scan (%BC): 18.93] [MRI OP (%BC): 18.93] [Positron Emission Tomography (%BC): 18.93] [Radiology (%BC): 18.93] [Laboratory (%BC): 50.30] [Occupational Therapy (%BC): 50.30] [Physical Therapy (%BC): 50.30] [Speech Therapy (%BC): 50.30] [Other Outpatient Implant (%BC): 24.52] [IV Therapy (%BC): 50.30] [All Other OP (%BC): 50.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 27.6] [Cardiac Cath (%BC): 27.6] [Observation (%BC): 42.8] [Emergency Department (%BC): 42.8] [Occupational Therapy (%BC): 27.6] [Physical Therapy (%BC): 27.6] [Respiratory Services/Therapy  (%BC): 27.6] [Speech Therapy (%BC): 27.6] [All Other OP (%BC): 27.6]","count":"1 through 10","median_amount":16772.72,"10th_percentile":16772.72,"90th_percentile":16772.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"First Health/Coventry","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":4351.53,"10th_percentile":4351.53,"90th_percentile":4351.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 60.4] [Cardiac Cath (%BC): 60.4] [Observation (%BC): 53.7] [Emergency Department (%BC): 53.7] [Occupational Therapy (%BC): 60.4] [Physical Therapy (%BC): 60.4] [Respiratory Services/Therapy  (%BC): 60.4] [Speech Therapy (%BC): 60.4] [All Other OP (%BC): 60.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Nerve Injections","code_information":[{"code":"5442","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 33.9] [Cardiac Cath (%BC): 33.9] [Observation (%BC): 57.7] [Emergency Department (%BC): 57.7] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 33.9] [Occupational Therapy (%BC): 33.9] [Physical Therapy (%BC): 33.9] [Respiratory Services/Therapy  (%BC): 33.9] [Speech Therapy (%BC): 33.9] [All Other OP (%BC): 33.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Avmed","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Baycare Plus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 30.92] [Cardiac Cath (%BC): 30.92] [Lithotripsy (%BC): 30.92] [PTCA (%BC): 30.92] [Observation (%BC): 47.84] [Emergency Department (%BC): 47.84] [Other Cardiac Testing (%BC): 41.01] [EEG (%BC): 41.01] [Chemotherapy (%BC): 41.01] [Nuclear Medicine (%BC): 15.94] [Radiation Therapy  (%BC): 41.01] [CT OP Scan (%BC): 15.94] [MRI OP (%BC): 15.94] [Positron Emission Tomography (%BC): 15.94] [Radiology (%BC): 15.94] [Laboratory (%BC): 41.01] [Occupational Therapy (%BC): 41.01] [Physical Therapy (%BC): 41.01] [Speech Therapy (%BC): 41.01] [Other Outpatient Implant (%BC): 24.52] [IV Therapy (%BC): 41.01] [All Other OP (%BC): 41.01]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50] [All Other OP (%BC): 16.218]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 45.89] [Cardiac Cath (%BC): 45.89] [Lithotripsy (%BC): 45.89] [PTCA (%BC): 45.89] [Observation (%BC): 55.14] [Emergency Department (%BC): 55.14] [Other Cardiac Testing (%BC): 50.30] [EEG (%BC): 50.30] [Chemotherapy (%BC): 50.30] [Nuclear Medicine (%BC): 18.93] [Radiation Therapy  (%BC): 50.30] [CT OP Scan (%BC): 18.93] [MRI OP (%BC): 18.93] [Positron Emission Tomography (%BC): 18.93] [Radiology (%BC): 18.93] [Laboratory (%BC): 50.30] [Occupational Therapy (%BC): 50.30] [Physical Therapy (%BC): 50.30] [Speech Therapy (%BC): 50.30] [Other Outpatient Implant (%BC): 24.52] [IV Therapy (%BC): 50.30] [All Other OP (%BC): 50.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 27.6] [Cardiac Cath (%BC): 27.6] [Observation (%BC): 42.8] [Emergency Department (%BC): 42.8] [Occupational Therapy (%BC): 27.6] [Physical Therapy (%BC): 27.6] [Respiratory Services/Therapy  (%BC): 27.6] [Speech Therapy (%BC): 27.6] [All Other OP (%BC): 27.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1204.21,"10th_percentile":1204.21,"90th_percentile":1204.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 60.4] [Cardiac Cath (%BC): 60.4] [Observation (%BC): 53.7] [Emergency Department (%BC): 53.7] [Occupational Therapy (%BC): 60.4] [Physical Therapy (%BC): 60.4] [Respiratory Services/Therapy  (%BC): 60.4] [Speech Therapy (%BC): 60.4] [All Other OP (%BC): 60.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Neurostimulator and Related Procedures","code_information":[{"code":"5461","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 33.9] [Cardiac Cath (%BC): 33.9] [Observation (%BC): 57.7] [Emergency Department (%BC): 57.7] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 33.9] [Occupational Therapy (%BC): 33.9] [Physical Therapy (%BC): 33.9] [Respiratory Services/Therapy  (%BC): 33.9] [Speech Therapy (%BC): 33.9] [All Other OP (%BC): 33.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Avmed","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Baycare Plus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 30.92] [Cardiac Cath (%BC): 30.92] [Lithotripsy (%BC): 30.92] [PTCA (%BC): 30.92] [Observation (%BC): 47.84] [Emergency Department (%BC): 47.84] [Other Cardiac Testing (%BC): 41.01] [EEG (%BC): 41.01] [Chemotherapy (%BC): 41.01] [Nuclear Medicine (%BC): 15.94] [Radiation Therapy  (%BC): 41.01] [CT OP Scan (%BC): 15.94] [MRI OP (%BC): 15.94] [Positron Emission Tomography (%BC): 15.94] [Radiology (%BC): 15.94] [Laboratory (%BC): 41.01] [Occupational Therapy (%BC): 41.01] [Physical Therapy (%BC): 41.01] [Speech Therapy (%BC): 41.01] [Other Outpatient Implant (%BC): 24.52] [IV Therapy (%BC): 41.01] [All Other OP (%BC): 41.01]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50] [All Other OP (%BC): 16.218]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 45.89] [Cardiac Cath (%BC): 45.89] [Lithotripsy (%BC): 45.89] [PTCA (%BC): 45.89] [Observation (%BC): 55.14] [Emergency Department (%BC): 55.14] [Other Cardiac Testing (%BC): 50.30] [EEG (%BC): 50.30] [Chemotherapy (%BC): 50.30] [Nuclear Medicine (%BC): 18.93] [Radiation Therapy  (%BC): 50.30] [CT OP Scan (%BC): 18.93] [MRI OP (%BC): 18.93] [Positron Emission Tomography (%BC): 18.93] [Radiology (%BC): 18.93] [Laboratory (%BC): 50.30] [Occupational Therapy (%BC): 50.30] [Physical Therapy (%BC): 50.30] [Speech Therapy (%BC): 50.30] [Other Outpatient Implant (%BC): 24.52] [IV Therapy (%BC): 50.30] [All Other OP (%BC): 50.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 27.6] [Cardiac Cath (%BC): 27.6] [Observation (%BC): 42.8] [Emergency Department (%BC): 42.8] [Occupational Therapy (%BC): 27.6] [Physical Therapy (%BC): 27.6] [Respiratory Services/Therapy  (%BC): 27.6] [Speech Therapy (%BC): 27.6] [All Other OP (%BC): 27.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 60.4] [Cardiac Cath (%BC): 60.4] [Observation (%BC): 53.7] [Emergency Department (%BC): 53.7] [Occupational Therapy (%BC): 60.4] [Physical Therapy (%BC): 60.4] [Respiratory Services/Therapy  (%BC): 60.4] [Speech Therapy (%BC): 60.4] [All Other OP (%BC): 60.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3579.0,"10th_percentile":3579.0,"90th_percentile":3579.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Neurostimulator and Related Procedures","code_information":[{"code":"5462","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 33.9] [Cardiac Cath (%BC): 33.9] [Observation (%BC): 57.7] [Emergency Department (%BC): 57.7] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 33.9] [Occupational Therapy (%BC): 33.9] [Physical Therapy (%BC): 33.9] [Respiratory Services/Therapy  (%BC): 33.9] [Speech Therapy (%BC): 33.9] [All Other OP (%BC): 33.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Avmed","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Baycare Plus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":6587.71,"10th_percentile":6587.71,"90th_percentile":6587.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 30.92] [Cardiac Cath (%BC): 30.92] [Lithotripsy (%BC): 30.92] [PTCA (%BC): 30.92] [Observation (%BC): 47.84] [Emergency Department (%BC): 47.84] [Other Cardiac Testing (%BC): 41.01] [EEG (%BC): 41.01] [Chemotherapy (%BC): 41.01] [Nuclear Medicine (%BC): 15.94] [Radiation Therapy  (%BC): 41.01] [CT OP Scan (%BC): 15.94] [MRI OP (%BC): 15.94] [Positron Emission Tomography (%BC): 15.94] [Radiology (%BC): 15.94] [Laboratory (%BC): 41.01] [Occupational Therapy (%BC): 41.01] [Physical Therapy (%BC): 41.01] [Speech Therapy (%BC): 41.01] [Other Outpatient Implant (%BC): 24.52] [IV Therapy (%BC): 41.01] [All Other OP (%BC): 41.01]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50] [All Other OP (%BC): 16.218]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 45.89] [Cardiac Cath (%BC): 45.89] [Lithotripsy (%BC): 45.89] [PTCA (%BC): 45.89] [Observation (%BC): 55.14] [Emergency Department (%BC): 55.14] [Other Cardiac Testing (%BC): 50.30] [EEG (%BC): 50.30] [Chemotherapy (%BC): 50.30] [Nuclear Medicine (%BC): 18.93] [Radiation Therapy  (%BC): 50.30] [CT OP Scan (%BC): 18.93] [MRI OP (%BC): 18.93] [Positron Emission Tomography (%BC): 18.93] [Radiology (%BC): 18.93] [Laboratory (%BC): 50.30] [Occupational Therapy (%BC): 50.30] [Physical Therapy (%BC): 50.30] [Speech Therapy (%BC): 50.30] [Other Outpatient Implant (%BC): 24.52] [IV Therapy (%BC): 50.30] [All Other OP (%BC): 50.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 27.6] [Cardiac Cath (%BC): 27.6] [Observation (%BC): 42.8] [Emergency Department (%BC): 42.8] [Occupational Therapy (%BC): 27.6] [Physical Therapy (%BC): 27.6] [Respiratory Services/Therapy  (%BC): 27.6] [Speech Therapy (%BC): 27.6] [All Other OP (%BC): 27.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 60.4] [Cardiac Cath (%BC): 60.4] [Observation (%BC): 53.7] [Emergency Department (%BC): 53.7] [Occupational Therapy (%BC): 60.4] [Physical Therapy (%BC): 60.4] [Respiratory Services/Therapy  (%BC): 60.4] [Speech Therapy (%BC): 60.4] [All Other OP (%BC): 60.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 4 Neurostimulator and Related Procedures","code_information":[{"code":"5464","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 33.9] [Cardiac Cath (%BC): 33.9] [Observation (%BC): 57.7] [Emergency Department (%BC): 57.7] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 33.9] [Occupational Therapy (%BC): 33.9] [Physical Therapy (%BC): 33.9] [Respiratory Services/Therapy  (%BC): 33.9] [Speech Therapy (%BC): 33.9] [All Other OP (%BC): 33.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Avmed","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Baycare Plus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":9574.01,"10th_percentile":9574.01,"90th_percentile":9574.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 30.92] [Cardiac Cath (%BC): 30.92] [Lithotripsy (%BC): 30.92] [PTCA (%BC): 30.92] [Observation (%BC): 47.84] [Emergency Department (%BC): 47.84] [Other Cardiac Testing (%BC): 41.01] [EEG (%BC): 41.01] [Chemotherapy (%BC): 41.01] [Nuclear Medicine (%BC): 15.94] [Radiation Therapy  (%BC): 41.01] [CT OP Scan (%BC): 15.94] [MRI OP (%BC): 15.94] [Positron Emission Tomography (%BC): 15.94] [Radiology (%BC): 15.94] [Laboratory (%BC): 41.01] [Occupational Therapy (%BC): 41.01] [Physical Therapy (%BC): 41.01] [Speech Therapy (%BC): 41.01] [Other Outpatient Implant (%BC): 24.52] [IV Therapy (%BC): 41.01] [All Other OP (%BC): 41.01]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50] [All Other OP (%BC): 16.218]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 45.89] [Cardiac Cath (%BC): 45.89] [Lithotripsy (%BC): 45.89] [PTCA (%BC): 45.89] [Observation (%BC): 55.14] [Emergency Department (%BC): 55.14] [Other Cardiac Testing (%BC): 50.30] [EEG (%BC): 50.30] [Chemotherapy (%BC): 50.30] [Nuclear Medicine (%BC): 18.93] [Radiation Therapy  (%BC): 50.30] [CT OP Scan (%BC): 18.93] [MRI OP (%BC): 18.93] [Positron Emission Tomography (%BC): 18.93] [Radiology (%BC): 18.93] [Laboratory (%BC): 50.30] [Occupational Therapy (%BC): 50.30] [Physical Therapy (%BC): 50.30] [Speech Therapy (%BC): 50.30] [Other Outpatient Implant (%BC): 24.52] [IV Therapy (%BC): 50.30] [All Other OP (%BC): 50.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 27.6] [Cardiac Cath (%BC): 27.6] [Observation (%BC): 42.8] [Emergency Department (%BC): 42.8] [Occupational Therapy (%BC): 27.6] [Physical Therapy (%BC): 27.6] [Respiratory Services/Therapy  (%BC): 27.6] [Speech Therapy (%BC): 27.6] [All Other OP (%BC): 27.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":12733.27,"10th_percentile":12733.27,"90th_percentile":12733.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 60.4] [Cardiac Cath (%BC): 60.4] [Observation (%BC): 53.7] [Emergency Department (%BC): 53.7] [Occupational Therapy (%BC): 60.4] [Physical Therapy (%BC): 60.4] [Respiratory Services/Therapy  (%BC): 60.4] [Speech Therapy (%BC): 60.4] [All Other OP (%BC): 60.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Imaging without Contrast","code_information":[{"code":"5521","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 33.9] [Cardiac Cath (%BC): 33.9] [Observation (%BC): 57.7] [Emergency Department (%BC): 57.7] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 33.9] [Occupational Therapy (%BC): 33.9] [Physical Therapy (%BC): 33.9] [Respiratory Services/Therapy  (%BC): 33.9] [Speech Therapy (%BC): 33.9] [All Other OP (%BC): 33.9]","count":"18","median_amount":5669.9,"10th_percentile":1060.89,"90th_percentile":7162.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":135.92,"10th_percentile":135.92,"90th_percentile":207.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":718.82,"10th_percentile":90.58,"90th_percentile":865.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Avmed","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Baycare Plus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":88.38,"10th_percentile":88.38,"90th_percentile":88.38,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 30.92] [Cardiac Cath (%BC): 30.92] [Lithotripsy (%BC): 30.92] [PTCA (%BC): 30.92] [Observation (%BC): 47.84] [Emergency Department (%BC): 47.84] [Other Cardiac Testing (%BC): 41.01] [EEG (%BC): 41.01] [Chemotherapy (%BC): 41.01] [Nuclear Medicine (%BC): 15.94] [Radiation Therapy  (%BC): 41.01] [CT OP Scan (%BC): 15.94] [MRI OP (%BC): 15.94] [Positron Emission Tomography (%BC): 15.94] [Radiology (%BC): 15.94] [Laboratory (%BC): 41.01] [Occupational Therapy (%BC): 41.01] [Physical Therapy (%BC): 41.01] [Speech Therapy (%BC): 41.01] [Other Outpatient Implant (%BC): 24.52] [IV Therapy (%BC): 41.01] [All Other OP (%BC): 41.01]","count":"26","median_amount":4545.94,"10th_percentile":337.41,"90th_percentile":5250.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50] [All Other OP (%BC): 16.218]","count":"1 through 10","median_amount":717.88,"10th_percentile":717.88,"90th_percentile":717.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 45.89] [Cardiac Cath (%BC): 45.89] [Lithotripsy (%BC): 45.89] [PTCA (%BC): 45.89] [Observation (%BC): 55.14] [Emergency Department (%BC): 55.14] [Other Cardiac Testing (%BC): 50.30] [EEG (%BC): 50.30] [Chemotherapy (%BC): 50.30] [Nuclear Medicine (%BC): 18.93] [Radiation Therapy  (%BC): 50.30] [CT OP Scan (%BC): 18.93] [MRI OP (%BC): 18.93] [Positron Emission Tomography (%BC): 18.93] [Radiology (%BC): 18.93] [Laboratory (%BC): 50.30] [Occupational Therapy (%BC): 50.30] [Physical Therapy (%BC): 50.30] [Speech Therapy (%BC): 50.30] [Other Outpatient Implant (%BC): 24.52] [IV Therapy (%BC): 50.30] [All Other OP (%BC): 50.30]","count":"1 through 10","median_amount":4810.68,"10th_percentile":4810.68,"90th_percentile":4810.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 27.6] [Cardiac Cath (%BC): 27.6] [Observation (%BC): 42.8] [Emergency Department (%BC): 42.8] [Occupational Therapy (%BC): 27.6] [Physical Therapy (%BC): 27.6] [Respiratory Services/Therapy  (%BC): 27.6] [Speech Therapy (%BC): 27.6] [All Other OP (%BC): 27.6]","count":"23","median_amount":3350.27,"10th_percentile":766.05,"90th_percentile":5431.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"First Health/Coventry","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"1 through 10","median_amount":1183.96,"10th_percentile":1183.96,"90th_percentile":1183.96},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":122.35,"10th_percentile":113.04,"90th_percentile":130.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":645.27,"10th_percentile":87.5,"90th_percentile":832.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"20","median_amount":115.31,"10th_percentile":37.4,"90th_percentile":159.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"27","median_amount":1129.87,"10th_percentile":196.2,"90th_percentile":1562.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"36","median_amount":140.96,"10th_percentile":115.24,"90th_percentile":280.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 60.4] [Cardiac Cath (%BC): 60.4] [Observation (%BC): 53.7] [Emergency Department (%BC): 53.7] [Occupational Therapy (%BC): 60.4] [Physical Therapy (%BC): 60.4] [Respiratory Services/Therapy  (%BC): 60.4] [Speech Therapy (%BC): 60.4] [All Other OP (%BC): 60.4]","count":"1 through 10","median_amount":155.3,"10th_percentile":155.3,"90th_percentile":155.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":681.14,"10th_percentile":92.8,"90th_percentile":732.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":931.24,"10th_percentile":931.24,"90th_percentile":931.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 2 Imaging without Contrast","code_information":[{"code":"5522","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 33.9] [Cardiac Cath (%BC): 33.9] [Observation (%BC): 57.7] [Emergency Department (%BC): 57.7] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 33.9] [Occupational Therapy (%BC): 33.9] [Physical Therapy (%BC): 33.9] [Respiratory Services/Therapy  (%BC): 33.9] [Speech Therapy (%BC): 33.9] [All Other OP (%BC): 33.9]","count":"20","median_amount":2539.76,"10th_percentile":299.95,"90th_percentile":9808.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"12","median_amount":112.05,"10th_percentile":70.71,"90th_percentile":382.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":665.37,"10th_percentile":108.79,"90th_percentile":667.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Avmed","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Baycare Plus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 30.92] [Cardiac Cath (%BC): 30.92] [Lithotripsy (%BC): 30.92] [PTCA (%BC): 30.92] [Observation (%BC): 47.84] [Emergency Department (%BC): 47.84] [Other Cardiac Testing (%BC): 41.01] [EEG (%BC): 41.01] [Chemotherapy (%BC): 41.01] [Nuclear Medicine (%BC): 15.94] [Radiation Therapy  (%BC): 41.01] [CT OP Scan (%BC): 15.94] [MRI OP (%BC): 15.94] [Positron Emission Tomography (%BC): 15.94] [Radiology (%BC): 15.94] [Laboratory (%BC): 41.01] [Occupational Therapy (%BC): 41.01] [Physical Therapy (%BC): 41.01] [Speech Therapy (%BC): 41.01] [Other Outpatient Implant (%BC): 24.52] [IV Therapy (%BC): 41.01] [All Other OP (%BC): 41.01]","count":"22","median_amount":3822.35,"10th_percentile":1121.88,"90th_percentile":10023.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50] [All Other OP (%BC): 16.218]","count":"1 through 10","median_amount":665.89,"10th_percentile":665.89,"90th_percentile":1171.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 45.89] [Cardiac Cath (%BC): 45.89] [Lithotripsy (%BC): 45.89] [PTCA (%BC): 45.89] [Observation (%BC): 55.14] [Emergency Department (%BC): 55.14] [Other Cardiac Testing (%BC): 50.30] [EEG (%BC): 50.30] [Chemotherapy (%BC): 50.30] [Nuclear Medicine (%BC): 18.93] [Radiation Therapy  (%BC): 50.30] [CT OP Scan (%BC): 18.93] [MRI OP (%BC): 18.93] [Positron Emission Tomography (%BC): 18.93] [Radiology (%BC): 18.93] [Laboratory (%BC): 50.30] [Occupational Therapy (%BC): 50.30] [Physical Therapy (%BC): 50.30] [Speech Therapy (%BC): 50.30] [Other Outpatient Implant (%BC): 24.52] [IV Therapy (%BC): 50.30] [All Other OP (%BC): 50.30]","count":"1 through 10","median_amount":10336.23,"10th_percentile":10336.23,"90th_percentile":10336.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1061.89,"10th_percentile":1061.89,"90th_percentile":1130.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 27.6] [Cardiac Cath (%BC): 27.6] [Observation (%BC): 42.8] [Emergency Department (%BC): 42.8] [Occupational Therapy (%BC): 27.6] [Physical Therapy (%BC): 27.6] [Respiratory Services/Therapy  (%BC): 27.6] [Speech Therapy (%BC): 27.6] [All Other OP (%BC): 27.6]","count":"26","median_amount":4906.27,"10th_percentile":320.84,"90th_percentile":8620.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"First Health/Coventry","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"1 through 10","median_amount":76.41,"10th_percentile":76.41,"90th_percentile":76.41},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":367.14,"10th_percentile":180.38,"90th_percentile":367.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"13","median_amount":524.99,"10th_percentile":106.74,"90th_percentile":913.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":975.4,"10th_percentile":975.4,"90th_percentile":975.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"18","median_amount":247.37,"10th_percentile":73.37,"90th_percentile":423.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1211.36,"10th_percentile":1211.36,"90th_percentile":1211.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"23","median_amount":853.99,"10th_percentile":236.96,"90th_percentile":1185.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"27","median_amount":183.87,"10th_percentile":73.33,"90th_percentile":374.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 60.4] [Cardiac Cath (%BC): 60.4] [Observation (%BC): 53.7] [Emergency Department (%BC): 53.7] [Occupational Therapy (%BC): 60.4] [Physical Therapy (%BC): 60.4] [Respiratory Services/Therapy  (%BC): 60.4] [Speech Therapy (%BC): 60.4] [All Other OP (%BC): 60.4]","count":"1 through 10","median_amount":13836.95,"10th_percentile":3855.77,"90th_percentile":33343.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"14","median_amount":552.41,"10th_percentile":112.08,"90th_percentile":958.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 3 Imaging without Contrast","code_information":[{"code":"5523","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 33.9] [Cardiac Cath (%BC): 33.9] [Observation (%BC): 57.7] [Emergency Department (%BC): 57.7] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 33.9] [Occupational Therapy (%BC): 33.9] [Physical Therapy (%BC): 33.9] [Respiratory Services/Therapy  (%BC): 33.9] [Speech Therapy (%BC): 33.9] [All Other OP (%BC): 33.9]","count":"1 through 10","median_amount":947.75,"10th_percentile":927.43,"90th_percentile":10386.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":155.03,"10th_percentile":155.03,"90th_percentile":155.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":250.29,"10th_percentile":250.29,"90th_percentile":250.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Avmed","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Baycare Plus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 30.92] [Cardiac Cath (%BC): 30.92] [Lithotripsy (%BC): 30.92] [PTCA (%BC): 30.92] [Observation (%BC): 47.84] [Emergency Department (%BC): 47.84] [Other Cardiac Testing (%BC): 41.01] [EEG (%BC): 41.01] [Chemotherapy (%BC): 41.01] [Nuclear Medicine (%BC): 15.94] [Radiation Therapy  (%BC): 41.01] [CT OP Scan (%BC): 15.94] [MRI OP (%BC): 15.94] [Positron Emission Tomography (%BC): 15.94] [Radiology (%BC): 15.94] [Laboratory (%BC): 41.01] [Occupational Therapy (%BC): 41.01] [Physical Therapy (%BC): 41.01] [Speech Therapy (%BC): 41.01] [Other Outpatient Implant (%BC): 24.52] [IV Therapy (%BC): 41.01] [All Other OP (%BC): 41.01]","count":"1 through 10","median_amount":1331.75,"10th_percentile":793.83,"90th_percentile":8043.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50] [All Other OP (%BC): 16.218]","count":"1 through 10","median_amount":247.48,"10th_percentile":247.48,"90th_percentile":683.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 45.89] [Cardiac Cath (%BC): 45.89] [Lithotripsy (%BC): 45.89] [PTCA (%BC): 45.89] [Observation (%BC): 55.14] [Emergency Department (%BC): 55.14] [Other Cardiac Testing (%BC): 50.30] [EEG (%BC): 50.30] [Chemotherapy (%BC): 50.30] [Nuclear Medicine (%BC): 18.93] [Radiation Therapy  (%BC): 50.30] [CT OP Scan (%BC): 18.93] [MRI OP (%BC): 18.93] [Positron Emission Tomography (%BC): 18.93] [Radiology (%BC): 18.93] [Laboratory (%BC): 50.30] [Occupational Therapy (%BC): 50.30] [Physical Therapy (%BC): 50.30] [Speech Therapy (%BC): 50.30] [Other Outpatient Implant (%BC): 24.52] [IV Therapy (%BC): 50.30] [All Other OP (%BC): 50.30]","count":"1 through 10","median_amount":1394.78,"10th_percentile":1394.78,"90th_percentile":1394.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 27.6] [Cardiac Cath (%BC): 27.6] [Observation (%BC): 42.8] [Emergency Department (%BC): 42.8] [Occupational Therapy (%BC): 27.6] [Physical Therapy (%BC): 27.6] [Respiratory Services/Therapy  (%BC): 27.6] [Speech Therapy (%BC): 27.6] [All Other OP (%BC): 27.6]","count":"1 through 10","median_amount":8045.12,"10th_percentile":6633.63,"90th_percentile":9996.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"First Health/Coventry","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":659.16,"10th_percentile":659.16,"90th_percentile":7637.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":182.12,"10th_percentile":160.88,"90th_percentile":275.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":254.05,"10th_percentile":254.05,"90th_percentile":254.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":538.64,"10th_percentile":538.64,"90th_percentile":2874.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":387.38,"10th_percentile":387.38,"90th_percentile":387.38,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 60.4] [Cardiac Cath (%BC): 60.4] [Observation (%BC): 53.7] [Emergency Department (%BC): 53.7] [Occupational Therapy (%BC): 60.4] [Physical Therapy (%BC): 60.4] [Respiratory Services/Therapy  (%BC): 60.4] [Speech Therapy (%BC): 60.4] [All Other OP (%BC): 60.4]","count":"1 through 10","median_amount":5138.63,"10th_percentile":5138.63,"90th_percentile":10032.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":691.98,"10th_percentile":691.98,"90th_percentile":1002.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":574.17,"10th_percentile":574.17,"90th_percentile":574.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 4 Imaging without Contrast","code_information":[{"code":"5524","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 33.9] [Cardiac Cath (%BC): 33.9] [Observation (%BC): 57.7] [Emergency Department (%BC): 57.7] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 33.9] [Occupational Therapy (%BC): 33.9] [Physical Therapy (%BC): 33.9] [Respiratory Services/Therapy  (%BC): 33.9] [Speech Therapy (%BC): 33.9] [All Other OP (%BC): 33.9]","count":"1 through 10","median_amount":1736.68,"10th_percentile":1225.19,"90th_percentile":7872.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":302.84,"10th_percentile":302.84,"90th_percentile":302.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":565.84,"10th_percentile":565.84,"90th_percentile":565.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Avmed","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Baycare Plus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 30.92] [Cardiac Cath (%BC): 30.92] [Lithotripsy (%BC): 30.92] [PTCA (%BC): 30.92] [Observation (%BC): 47.84] [Emergency Department (%BC): 47.84] [Other Cardiac Testing (%BC): 41.01] [EEG (%BC): 41.01] [Chemotherapy (%BC): 41.01] [Nuclear Medicine (%BC): 15.94] [Radiation Therapy  (%BC): 41.01] [CT OP Scan (%BC): 15.94] [MRI OP (%BC): 15.94] [Positron Emission Tomography (%BC): 15.94] [Radiology (%BC): 15.94] [Laboratory (%BC): 41.01] [Occupational Therapy (%BC): 41.01] [Physical Therapy (%BC): 41.01] [Speech Therapy (%BC): 41.01] [Other Outpatient Implant (%BC): 24.52] [IV Therapy (%BC): 41.01] [All Other OP (%BC): 41.01]","count":"1 through 10","median_amount":2209.33,"10th_percentile":2209.33,"90th_percentile":2209.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50] [All Other OP (%BC): 16.218]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 45.89] [Cardiac Cath (%BC): 45.89] [Lithotripsy (%BC): 45.89] [PTCA (%BC): 45.89] [Observation (%BC): 55.14] [Emergency Department (%BC): 55.14] [Other Cardiac Testing (%BC): 50.30] [EEG (%BC): 50.30] [Chemotherapy (%BC): 50.30] [Nuclear Medicine (%BC): 18.93] [Radiation Therapy  (%BC): 50.30] [CT OP Scan (%BC): 18.93] [MRI OP (%BC): 18.93] [Positron Emission Tomography (%BC): 18.93] [Radiology (%BC): 18.93] [Laboratory (%BC): 50.30] [Occupational Therapy (%BC): 50.30] [Physical Therapy (%BC): 50.30] [Speech Therapy (%BC): 50.30] [Other Outpatient Implant (%BC): 24.52] [IV Therapy (%BC): 50.30] [All Other OP (%BC): 50.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 27.6] [Cardiac Cath (%BC): 27.6] [Observation (%BC): 42.8] [Emergency Department (%BC): 42.8] [Occupational Therapy (%BC): 27.6] [Physical Therapy (%BC): 27.6] [Respiratory Services/Therapy  (%BC): 27.6] [Speech Therapy (%BC): 27.6] [All Other OP (%BC): 27.6]","count":"1 through 10","median_amount":1118.1,"10th_percentile":1118.1,"90th_percentile":1118.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"First Health/Coventry","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":416.06,"10th_percentile":416.06,"90th_percentile":416.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1221.82,"10th_percentile":1221.82,"90th_percentile":1230.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 60.4] [Cardiac Cath (%BC): 60.4] [Observation (%BC): 53.7] [Emergency Department (%BC): 53.7] [Occupational Therapy (%BC): 60.4] [Physical Therapy (%BC): 60.4] [Respiratory Services/Therapy  (%BC): 60.4] [Speech Therapy (%BC): 60.4] [All Other OP (%BC): 60.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":576.89,"10th_percentile":576.89,"90th_percentile":1568.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Imaging with Contrast","code_information":[{"code":"5571","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 33.9] [Cardiac Cath (%BC): 33.9] [Observation (%BC): 57.7] [Emergency Department (%BC): 57.7] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 33.9] [Occupational Therapy (%BC): 33.9] [Physical Therapy (%BC): 33.9] [Respiratory Services/Therapy  (%BC): 33.9] [Speech Therapy (%BC): 33.9] [All Other OP (%BC): 33.9]","count":"1 through 10","median_amount":337.09,"10th_percentile":227.0,"90th_percentile":19550.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":183.12,"10th_percentile":183.12,"90th_percentile":183.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Avmed","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Baycare Plus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 30.92] [Cardiac Cath (%BC): 30.92] [Lithotripsy (%BC): 30.92] [PTCA (%BC): 30.92] [Observation (%BC): 47.84] [Emergency Department (%BC): 47.84] [Other Cardiac Testing (%BC): 41.01] [EEG (%BC): 41.01] [Chemotherapy (%BC): 41.01] [Nuclear Medicine (%BC): 15.94] [Radiation Therapy  (%BC): 41.01] [CT OP Scan (%BC): 15.94] [MRI OP (%BC): 15.94] [Positron Emission Tomography (%BC): 15.94] [Radiology (%BC): 15.94] [Laboratory (%BC): 41.01] [Occupational Therapy (%BC): 41.01] [Physical Therapy (%BC): 41.01] [Speech Therapy (%BC): 41.01] [Other Outpatient Implant (%BC): 24.52] [IV Therapy (%BC): 41.01] [All Other OP (%BC): 41.01]","count":"1 through 10","median_amount":287.14,"10th_percentile":160.01,"90th_percentile":4897.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50] [All Other OP (%BC): 16.218]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 45.89] [Cardiac Cath (%BC): 45.89] [Lithotripsy (%BC): 45.89] [PTCA (%BC): 45.89] [Observation (%BC): 55.14] [Emergency Department (%BC): 55.14] [Other Cardiac Testing (%BC): 50.30] [EEG (%BC): 50.30] [Chemotherapy (%BC): 50.30] [Nuclear Medicine (%BC): 18.93] [Radiation Therapy  (%BC): 50.30] [CT OP Scan (%BC): 18.93] [MRI OP (%BC): 18.93] [Positron Emission Tomography (%BC): 18.93] [Radiology (%BC): 18.93] [Laboratory (%BC): 50.30] [Occupational Therapy (%BC): 50.30] [Physical Therapy (%BC): 50.30] [Speech Therapy (%BC): 50.30] [Other Outpatient Implant (%BC): 24.52] [IV Therapy (%BC): 50.30] [All Other OP (%BC): 50.30]","count":"1 through 10","median_amount":177.44,"10th_percentile":177.44,"90th_percentile":177.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 27.6] [Cardiac Cath (%BC): 27.6] [Observation (%BC): 42.8] [Emergency Department (%BC): 42.8] [Occupational Therapy (%BC): 27.6] [Physical Therapy (%BC): 27.6] [Respiratory Services/Therapy  (%BC): 27.6] [Speech Therapy (%BC): 27.6] [All Other OP (%BC): 27.6]","count":"12","median_amount":10686.37,"10th_percentile":1318.55,"90th_percentile":15020.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"First Health/Coventry","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1004.62,"10th_percentile":1004.62,"90th_percentile":1004.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":326.29,"10th_percentile":326.29,"90th_percentile":326.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":549.25,"10th_percentile":549.25,"90th_percentile":549.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":920.82,"10th_percentile":920.82,"90th_percentile":920.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":396.69,"10th_percentile":396.69,"90th_percentile":2497.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":396.88,"10th_percentile":396.88,"90th_percentile":396.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 60.4] [Cardiac Cath (%BC): 60.4] [Observation (%BC): 53.7] [Emergency Department (%BC): 53.7] [Occupational Therapy (%BC): 60.4] [Physical Therapy (%BC): 60.4] [Respiratory Services/Therapy  (%BC): 60.4] [Speech Therapy (%BC): 60.4] [All Other OP (%BC): 60.4]","count":"1 through 10","median_amount":687.89,"10th_percentile":687.89,"90th_percentile":5610.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":184.62,"10th_percentile":184.62,"90th_percentile":184.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Imaging with Contrast","code_information":[{"code":"5572","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 33.9] [Cardiac Cath (%BC): 33.9] [Observation (%BC): 57.7] [Emergency Department (%BC): 57.7] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 33.9] [Occupational Therapy (%BC): 33.9] [Physical Therapy (%BC): 33.9] [Respiratory Services/Therapy  (%BC): 33.9] [Speech Therapy (%BC): 33.9] [All Other OP (%BC): 33.9]","count":"11","median_amount":3050.56,"10th_percentile":901.03,"90th_percentile":17539.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":257.8,"10th_percentile":257.8,"90th_percentile":413.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":365.36,"10th_percentile":365.36,"90th_percentile":365.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Avmed","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Baycare Plus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 30.92] [Cardiac Cath (%BC): 30.92] [Lithotripsy (%BC): 30.92] [PTCA (%BC): 30.92] [Observation (%BC): 47.84] [Emergency Department (%BC): 47.84] [Other Cardiac Testing (%BC): 41.01] [EEG (%BC): 41.01] [Chemotherapy (%BC): 41.01] [Nuclear Medicine (%BC): 15.94] [Radiation Therapy  (%BC): 41.01] [CT OP Scan (%BC): 15.94] [MRI OP (%BC): 15.94] [Positron Emission Tomography (%BC): 15.94] [Radiology (%BC): 15.94] [Laboratory (%BC): 41.01] [Occupational Therapy (%BC): 41.01] [Physical Therapy (%BC): 41.01] [Speech Therapy (%BC): 41.01] [Other Outpatient Implant (%BC): 24.52] [IV Therapy (%BC): 41.01] [All Other OP (%BC): 41.01]","count":"1 through 10","median_amount":1348.74,"10th_percentile":1046.51,"90th_percentile":10711.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50] [All Other OP (%BC): 16.218]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 45.89] [Cardiac Cath (%BC): 45.89] [Lithotripsy (%BC): 45.89] [PTCA (%BC): 45.89] [Observation (%BC): 55.14] [Emergency Department (%BC): 55.14] [Other Cardiac Testing (%BC): 50.30] [EEG (%BC): 50.30] [Chemotherapy (%BC): 50.30] [Nuclear Medicine (%BC): 18.93] [Radiation Therapy  (%BC): 50.30] [CT OP Scan (%BC): 18.93] [MRI OP (%BC): 18.93] [Positron Emission Tomography (%BC): 18.93] [Radiology (%BC): 18.93] [Laboratory (%BC): 50.30] [Occupational Therapy (%BC): 50.30] [Physical Therapy (%BC): 50.30] [Speech Therapy (%BC): 50.30] [Other Outpatient Implant (%BC): 24.52] [IV Therapy (%BC): 50.30] [All Other OP (%BC): 50.30]","count":"1 through 10","median_amount":944.32,"10th_percentile":944.32,"90th_percentile":13538.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1526.6,"10th_percentile":1526.6,"90th_percentile":1526.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 27.6] [Cardiac Cath (%BC): 27.6] [Observation (%BC): 42.8] [Emergency Department (%BC): 42.8] [Occupational Therapy (%BC): 27.6] [Physical Therapy (%BC): 27.6] [Respiratory Services/Therapy  (%BC): 27.6] [Speech Therapy (%BC): 27.6] [All Other OP (%BC): 27.6]","count":"22","median_amount":10440.16,"10th_percentile":2463.23,"90th_percentile":11844.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"First Health/Coventry","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":437.92,"10th_percentile":437.92,"90th_percentile":961.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":654.58,"10th_percentile":654.58,"90th_percentile":1778.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":372.39,"10th_percentile":372.39,"90th_percentile":372.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2399.02,"10th_percentile":795.83,"90th_percentile":2745.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":387.06,"10th_percentile":89.68,"90th_percentile":387.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 60.4] [Cardiac Cath (%BC): 60.4] [Observation (%BC): 53.7] [Emergency Department (%BC): 53.7] [Occupational Therapy (%BC): 60.4] [Physical Therapy (%BC): 60.4] [Respiratory Services/Therapy  (%BC): 60.4] [Speech Therapy (%BC): 60.4] [All Other OP (%BC): 60.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"12","median_amount":370.38,"10th_percentile":370.38,"90th_percentile":370.38,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 3 Imaging with Contrast","code_information":[{"code":"5573","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 33.9] [Cardiac Cath (%BC): 33.9] [Observation (%BC): 57.7] [Emergency Department (%BC): 57.7] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 33.9] [Occupational Therapy (%BC): 33.9] [Physical Therapy (%BC): 33.9] [Respiratory Services/Therapy  (%BC): 33.9] [Speech Therapy (%BC): 33.9] [All Other OP (%BC): 33.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Avmed","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Baycare Plus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 30.92] [Cardiac Cath (%BC): 30.92] [Lithotripsy (%BC): 30.92] [PTCA (%BC): 30.92] [Observation (%BC): 47.84] [Emergency Department (%BC): 47.84] [Other Cardiac Testing (%BC): 41.01] [EEG (%BC): 41.01] [Chemotherapy (%BC): 41.01] [Nuclear Medicine (%BC): 15.94] [Radiation Therapy  (%BC): 41.01] [CT OP Scan (%BC): 15.94] [MRI OP (%BC): 15.94] [Positron Emission Tomography (%BC): 15.94] [Radiology (%BC): 15.94] [Laboratory (%BC): 41.01] [Occupational Therapy (%BC): 41.01] [Physical Therapy (%BC): 41.01] [Speech Therapy (%BC): 41.01] [Other Outpatient Implant (%BC): 24.52] [IV Therapy (%BC): 41.01] [All Other OP (%BC): 41.01]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50] [All Other OP (%BC): 16.218]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 45.89] [Cardiac Cath (%BC): 45.89] [Lithotripsy (%BC): 45.89] [PTCA (%BC): 45.89] [Observation (%BC): 55.14] [Emergency Department (%BC): 55.14] [Other Cardiac Testing (%BC): 50.30] [EEG (%BC): 50.30] [Chemotherapy (%BC): 50.30] [Nuclear Medicine (%BC): 18.93] [Radiation Therapy  (%BC): 50.30] [CT OP Scan (%BC): 18.93] [MRI OP (%BC): 18.93] [Positron Emission Tomography (%BC): 18.93] [Radiology (%BC): 18.93] [Laboratory (%BC): 50.30] [Occupational Therapy (%BC): 50.30] [Physical Therapy (%BC): 50.30] [Speech Therapy (%BC): 50.30] [Other Outpatient Implant (%BC): 24.52] [IV Therapy (%BC): 50.30] [All Other OP (%BC): 50.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":786.62,"10th_percentile":786.62,"90th_percentile":786.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 27.6] [Cardiac Cath (%BC): 27.6] [Observation (%BC): 42.8] [Emergency Department (%BC): 42.8] [Occupational Therapy (%BC): 27.6] [Physical Therapy (%BC): 27.6] [Respiratory Services/Therapy  (%BC): 27.6] [Speech Therapy (%BC): 27.6] [All Other OP (%BC): 27.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1448.11,"10th_percentile":1448.11,"90th_percentile":1448.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 60.4] [Cardiac Cath (%BC): 60.4] [Observation (%BC): 53.7] [Emergency Department (%BC): 53.7] [Occupational Therapy (%BC): 60.4] [Physical Therapy (%BC): 60.4] [Respiratory Services/Therapy  (%BC): 60.4] [Speech Therapy (%BC): 60.4] [All Other OP (%BC): 60.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":819.38,"10th_percentile":819.38,"90th_percentile":819.38,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Nuclear Medicine and Related Services","code_information":[{"code":"5591","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 33.9] [Cardiac Cath (%BC): 33.9] [Observation (%BC): 57.7] [Emergency Department (%BC): 57.7] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 33.9] [Occupational Therapy (%BC): 33.9] [Physical Therapy (%BC): 33.9] [Respiratory Services/Therapy  (%BC): 33.9] [Speech Therapy (%BC): 33.9] [All Other OP (%BC): 33.9]","count":"1 through 10","median_amount":1164.99,"10th_percentile":1164.99,"90th_percentile":1164.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":239.97,"10th_percentile":239.97,"90th_percentile":239.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":416.09,"10th_percentile":416.09,"90th_percentile":416.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Avmed","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Baycare Plus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 30.92] [Cardiac Cath (%BC): 30.92] [Lithotripsy (%BC): 30.92] [PTCA (%BC): 30.92] [Observation (%BC): 47.84] [Emergency Department (%BC): 47.84] [Other Cardiac Testing (%BC): 41.01] [EEG (%BC): 41.01] [Chemotherapy (%BC): 41.01] [Nuclear Medicine (%BC): 15.94] [Radiation Therapy  (%BC): 41.01] [CT OP Scan (%BC): 15.94] [MRI OP (%BC): 15.94] [Positron Emission Tomography (%BC): 15.94] [Radiology (%BC): 15.94] [Laboratory (%BC): 41.01] [Occupational Therapy (%BC): 41.01] [Physical Therapy (%BC): 41.01] [Speech Therapy (%BC): 41.01] [Other Outpatient Implant (%BC): 24.52] [IV Therapy (%BC): 41.01] [All Other OP (%BC): 41.01]","count":"1 through 10","median_amount":1116.87,"10th_percentile":1116.87,"90th_percentile":1116.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50] [All Other OP (%BC): 16.218]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 45.89] [Cardiac Cath (%BC): 45.89] [Lithotripsy (%BC): 45.89] [PTCA (%BC): 45.89] [Observation (%BC): 55.14] [Emergency Department (%BC): 55.14] [Other Cardiac Testing (%BC): 50.30] [EEG (%BC): 50.30] [Chemotherapy (%BC): 50.30] [Nuclear Medicine (%BC): 18.93] [Radiation Therapy  (%BC): 50.30] [CT OP Scan (%BC): 18.93] [MRI OP (%BC): 18.93] [Positron Emission Tomography (%BC): 18.93] [Radiology (%BC): 18.93] [Laboratory (%BC): 50.30] [Occupational Therapy (%BC): 50.30] [Physical Therapy (%BC): 50.30] [Speech Therapy (%BC): 50.30] [Other Outpatient Implant (%BC): 24.52] [IV Therapy (%BC): 50.30] [All Other OP (%BC): 50.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 27.6] [Cardiac Cath (%BC): 27.6] [Observation (%BC): 42.8] [Emergency Department (%BC): 42.8] [Occupational Therapy (%BC): 27.6] [Physical Therapy (%BC): 27.6] [Respiratory Services/Therapy  (%BC): 27.6] [Speech Therapy (%BC): 27.6] [All Other OP (%BC): 27.6]","count":"1 through 10","median_amount":882.78,"10th_percentile":882.78,"90th_percentile":882.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"First Health/Coventry","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":736.52,"10th_percentile":736.52,"90th_percentile":736.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":249.03,"10th_percentile":249.03,"90th_percentile":249.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":286.25,"10th_percentile":286.25,"90th_percentile":286.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 60.4] [Cardiac Cath (%BC): 60.4] [Observation (%BC): 53.7] [Emergency Department (%BC): 53.7] [Occupational Therapy (%BC): 60.4] [Physical Therapy (%BC): 60.4] [Respiratory Services/Therapy  (%BC): 60.4] [Speech Therapy (%BC): 60.4] [All Other OP (%BC): 60.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":416.74,"10th_percentile":416.74,"90th_percentile":419.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Nuclear Medicine and Related Services","code_information":[{"code":"5592","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 33.9] [Cardiac Cath (%BC): 33.9] [Observation (%BC): 57.7] [Emergency Department (%BC): 57.7] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 33.9] [Occupational Therapy (%BC): 33.9] [Physical Therapy (%BC): 33.9] [Respiratory Services/Therapy  (%BC): 33.9] [Speech Therapy (%BC): 33.9] [All Other OP (%BC): 33.9]","count":"1 through 10","median_amount":1363.46,"10th_percentile":1363.46,"90th_percentile":1363.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Avmed","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Baycare Plus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 30.92] [Cardiac Cath (%BC): 30.92] [Lithotripsy (%BC): 30.92] [PTCA (%BC): 30.92] [Observation (%BC): 47.84] [Emergency Department (%BC): 47.84] [Other Cardiac Testing (%BC): 41.01] [EEG (%BC): 41.01] [Chemotherapy (%BC): 41.01] [Nuclear Medicine (%BC): 15.94] [Radiation Therapy  (%BC): 41.01] [CT OP Scan (%BC): 15.94] [MRI OP (%BC): 15.94] [Positron Emission Tomography (%BC): 15.94] [Radiology (%BC): 15.94] [Laboratory (%BC): 41.01] [Occupational Therapy (%BC): 41.01] [Physical Therapy (%BC): 41.01] [Speech Therapy (%BC): 41.01] [Other Outpatient Implant (%BC): 24.52] [IV Therapy (%BC): 41.01] [All Other OP (%BC): 41.01]","count":"1 through 10","median_amount":2201.33,"10th_percentile":2201.33,"90th_percentile":2201.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50] [All Other OP (%BC): 16.218]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 45.89] [Cardiac Cath (%BC): 45.89] [Lithotripsy (%BC): 45.89] [PTCA (%BC): 45.89] [Observation (%BC): 55.14] [Emergency Department (%BC): 55.14] [Other Cardiac Testing (%BC): 50.30] [EEG (%BC): 50.30] [Chemotherapy (%BC): 50.30] [Nuclear Medicine (%BC): 18.93] [Radiation Therapy  (%BC): 50.30] [CT OP Scan (%BC): 18.93] [MRI OP (%BC): 18.93] [Positron Emission Tomography (%BC): 18.93] [Radiology (%BC): 18.93] [Laboratory (%BC): 50.30] [Occupational Therapy (%BC): 50.30] [Physical Therapy (%BC): 50.30] [Speech Therapy (%BC): 50.30] [Other Outpatient Implant (%BC): 24.52] [IV Therapy (%BC): 50.30] [All Other OP (%BC): 50.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 27.6] [Cardiac Cath (%BC): 27.6] [Observation (%BC): 42.8] [Emergency Department (%BC): 42.8] [Occupational Therapy (%BC): 27.6] [Physical Therapy (%BC): 27.6] [Respiratory Services/Therapy  (%BC): 27.6] [Speech Therapy (%BC): 27.6] [All Other OP (%BC): 27.6]","count":"1 through 10","median_amount":1417.02,"10th_percentile":1417.02,"90th_percentile":1417.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"First Health/Coventry","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 60.4] [Cardiac Cath (%BC): 60.4] [Observation (%BC): 53.7] [Emergency Department (%BC): 53.7] [Occupational Therapy (%BC): 60.4] [Physical Therapy (%BC): 60.4] [Respiratory Services/Therapy  (%BC): 60.4] [Speech Therapy (%BC): 60.4] [All Other OP (%BC): 60.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 3 Nuclear Medicine and Related Services","code_information":[{"code":"5593","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 33.9] [Cardiac Cath (%BC): 33.9] [Observation (%BC): 57.7] [Emergency Department (%BC): 57.7] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 33.9] [Occupational Therapy (%BC): 33.9] [Physical Therapy (%BC): 33.9] [Respiratory Services/Therapy  (%BC): 33.9] [Speech Therapy (%BC): 33.9] [All Other OP (%BC): 33.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Avmed","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Baycare Plus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 30.92] [Cardiac Cath (%BC): 30.92] [Lithotripsy (%BC): 30.92] [PTCA (%BC): 30.92] [Observation (%BC): 47.84] [Emergency Department (%BC): 47.84] [Other Cardiac Testing (%BC): 41.01] [EEG (%BC): 41.01] [Chemotherapy (%BC): 41.01] [Nuclear Medicine (%BC): 15.94] [Radiation Therapy  (%BC): 41.01] [CT OP Scan (%BC): 15.94] [MRI OP (%BC): 15.94] [Positron Emission Tomography (%BC): 15.94] [Radiology (%BC): 15.94] [Laboratory (%BC): 41.01] [Occupational Therapy (%BC): 41.01] [Physical Therapy (%BC): 41.01] [Speech Therapy (%BC): 41.01] [Other Outpatient Implant (%BC): 24.52] [IV Therapy (%BC): 41.01] [All Other OP (%BC): 41.01]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50] [All Other OP (%BC): 16.218]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 45.89] [Cardiac Cath (%BC): 45.89] [Lithotripsy (%BC): 45.89] [PTCA (%BC): 45.89] [Observation (%BC): 55.14] [Emergency Department (%BC): 55.14] [Other Cardiac Testing (%BC): 50.30] [EEG (%BC): 50.30] [Chemotherapy (%BC): 50.30] [Nuclear Medicine (%BC): 18.93] [Radiation Therapy  (%BC): 50.30] [CT OP Scan (%BC): 18.93] [MRI OP (%BC): 18.93] [Positron Emission Tomography (%BC): 18.93] [Radiology (%BC): 18.93] [Laboratory (%BC): 50.30] [Occupational Therapy (%BC): 50.30] [Physical Therapy (%BC): 50.30] [Speech Therapy (%BC): 50.30] [Other Outpatient Implant (%BC): 24.52] [IV Therapy (%BC): 50.30] [All Other OP (%BC): 50.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 27.6] [Cardiac Cath (%BC): 27.6] [Observation (%BC): 42.8] [Emergency Department (%BC): 42.8] [Occupational Therapy (%BC): 27.6] [Physical Therapy (%BC): 27.6] [Respiratory Services/Therapy  (%BC): 27.6] [Speech Therapy (%BC): 27.6] [All Other OP (%BC): 27.6]","count":"1 through 10","median_amount":4843.69,"10th_percentile":4843.69,"90th_percentile":4843.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"First Health/Coventry","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2392.81,"10th_percentile":2392.81,"90th_percentile":2392.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 60.4] [Cardiac Cath (%BC): 60.4] [Observation (%BC): 53.7] [Emergency Department (%BC): 53.7] [Occupational Therapy (%BC): 60.4] [Physical Therapy (%BC): 60.4] [Respiratory Services/Therapy  (%BC): 60.4] [Speech Therapy (%BC): 60.4] [All Other OP (%BC): 60.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1353.92,"10th_percentile":1353.92,"90th_percentile":1353.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 3 Pathology","code_information":[{"code":"5673","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 33.9] [Cardiac Cath (%BC): 33.9] [Observation (%BC): 57.7] [Emergency Department (%BC): 57.7] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 33.9] [Occupational Therapy (%BC): 33.9] [Physical Therapy (%BC): 33.9] [Respiratory Services/Therapy  (%BC): 33.9] [Speech Therapy (%BC): 33.9] [All Other OP (%BC): 33.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":368.01,"10th_percentile":368.01,"90th_percentile":368.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Avmed","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Baycare Plus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 30.92] [Cardiac Cath (%BC): 30.92] [Lithotripsy (%BC): 30.92] [PTCA (%BC): 30.92] [Observation (%BC): 47.84] [Emergency Department (%BC): 47.84] [Other Cardiac Testing (%BC): 41.01] [EEG (%BC): 41.01] [Chemotherapy (%BC): 41.01] [Nuclear Medicine (%BC): 15.94] [Radiation Therapy  (%BC): 41.01] [CT OP Scan (%BC): 15.94] [MRI OP (%BC): 15.94] [Positron Emission Tomography (%BC): 15.94] [Radiology (%BC): 15.94] [Laboratory (%BC): 41.01] [Occupational Therapy (%BC): 41.01] [Physical Therapy (%BC): 41.01] [Speech Therapy (%BC): 41.01] [Other Outpatient Implant (%BC): 24.52] [IV Therapy (%BC): 41.01] [All Other OP (%BC): 41.01]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50] [All Other OP (%BC): 16.218]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 45.89] [Cardiac Cath (%BC): 45.89] [Lithotripsy (%BC): 45.89] [PTCA (%BC): 45.89] [Observation (%BC): 55.14] [Emergency Department (%BC): 55.14] [Other Cardiac Testing (%BC): 50.30] [EEG (%BC): 50.30] [Chemotherapy (%BC): 50.30] [Nuclear Medicine (%BC): 18.93] [Radiation Therapy  (%BC): 50.30] [CT OP Scan (%BC): 18.93] [MRI OP (%BC): 18.93] [Positron Emission Tomography (%BC): 18.93] [Radiology (%BC): 18.93] [Laboratory (%BC): 50.30] [Occupational Therapy (%BC): 50.30] [Physical Therapy (%BC): 50.30] [Speech Therapy (%BC): 50.30] [Other Outpatient Implant (%BC): 24.52] [IV Therapy (%BC): 50.30] [All Other OP (%BC): 50.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 27.6] [Cardiac Cath (%BC): 27.6] [Observation (%BC): 42.8] [Emergency Department (%BC): 42.8] [Occupational Therapy (%BC): 27.6] [Physical Therapy (%BC): 27.6] [Respiratory Services/Therapy  (%BC): 27.6] [Speech Therapy (%BC): 27.6] [All Other OP (%BC): 27.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":304.95,"10th_percentile":304.95,"90th_percentile":304.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 60.4] [Cardiac Cath (%BC): 60.4] [Observation (%BC): 53.7] [Emergency Department (%BC): 53.7] [Occupational Therapy (%BC): 60.4] [Physical Therapy (%BC): 60.4] [Respiratory Services/Therapy  (%BC): 60.4] [Speech Therapy (%BC): 60.4] [All Other OP (%BC): 60.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 4 Pathology","code_information":[{"code":"5674","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 33.9] [Cardiac Cath (%BC): 33.9] [Observation (%BC): 57.7] [Emergency Department (%BC): 57.7] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 33.9] [Occupational Therapy (%BC): 33.9] [Physical Therapy (%BC): 33.9] [Respiratory Services/Therapy  (%BC): 33.9] [Speech Therapy (%BC): 33.9] [All Other OP (%BC): 33.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Avmed","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Baycare Plus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 30.92] [Cardiac Cath (%BC): 30.92] [Lithotripsy (%BC): 30.92] [PTCA (%BC): 30.92] [Observation (%BC): 47.84] [Emergency Department (%BC): 47.84] [Other Cardiac Testing (%BC): 41.01] [EEG (%BC): 41.01] [Chemotherapy (%BC): 41.01] [Nuclear Medicine (%BC): 15.94] [Radiation Therapy  (%BC): 41.01] [CT OP Scan (%BC): 15.94] [MRI OP (%BC): 15.94] [Positron Emission Tomography (%BC): 15.94] [Radiology (%BC): 15.94] [Laboratory (%BC): 41.01] [Occupational Therapy (%BC): 41.01] [Physical Therapy (%BC): 41.01] [Speech Therapy (%BC): 41.01] [Other Outpatient Implant (%BC): 24.52] [IV Therapy (%BC): 41.01] [All Other OP (%BC): 41.01]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50] [All Other OP (%BC): 16.218]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 45.89] [Cardiac Cath (%BC): 45.89] [Lithotripsy (%BC): 45.89] [PTCA (%BC): 45.89] [Observation (%BC): 55.14] [Emergency Department (%BC): 55.14] [Other Cardiac Testing (%BC): 50.30] [EEG (%BC): 50.30] [Chemotherapy (%BC): 50.30] [Nuclear Medicine (%BC): 18.93] [Radiation Therapy  (%BC): 50.30] [CT OP Scan (%BC): 18.93] [MRI OP (%BC): 18.93] [Positron Emission Tomography (%BC): 18.93] [Radiology (%BC): 18.93] [Laboratory (%BC): 50.30] [Occupational Therapy (%BC): 50.30] [Physical Therapy (%BC): 50.30] [Speech Therapy (%BC): 50.30] [Other Outpatient Implant (%BC): 24.52] [IV Therapy (%BC): 50.30] [All Other OP (%BC): 50.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 27.6] [Cardiac Cath (%BC): 27.6] [Observation (%BC): 42.8] [Emergency Department (%BC): 42.8] [Occupational Therapy (%BC): 27.6] [Physical Therapy (%BC): 27.6] [Respiratory Services/Therapy  (%BC): 27.6] [Speech Therapy (%BC): 27.6] [All Other OP (%BC): 27.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1820.38,"10th_percentile":1820.38,"90th_percentile":1820.38,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 60.4] [Cardiac Cath (%BC): 60.4] [Observation (%BC): 53.7] [Emergency Department (%BC): 53.7] [Occupational Therapy (%BC): 60.4] [Physical Therapy (%BC): 60.4] [Respiratory Services/Therapy  (%BC): 60.4] [Speech Therapy (%BC): 60.4] [All Other OP (%BC): 60.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Drug Administration","code_information":[{"code":"5691","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 33.9] [Cardiac Cath (%BC): 33.9] [Observation (%BC): 57.7] [Emergency Department (%BC): 57.7] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 33.9] [Occupational Therapy (%BC): 33.9] [Physical Therapy (%BC): 33.9] [Respiratory Services/Therapy  (%BC): 33.9] [Speech Therapy (%BC): 33.9] [All Other OP (%BC): 33.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Avmed","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Baycare Plus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 30.92] [Cardiac Cath (%BC): 30.92] [Lithotripsy (%BC): 30.92] [PTCA (%BC): 30.92] [Observation (%BC): 47.84] [Emergency Department (%BC): 47.84] [Other Cardiac Testing (%BC): 41.01] [EEG (%BC): 41.01] [Chemotherapy (%BC): 41.01] [Nuclear Medicine (%BC): 15.94] [Radiation Therapy  (%BC): 41.01] [CT OP Scan (%BC): 15.94] [MRI OP (%BC): 15.94] [Positron Emission Tomography (%BC): 15.94] [Radiology (%BC): 15.94] [Laboratory (%BC): 41.01] [Occupational Therapy (%BC): 41.01] [Physical Therapy (%BC): 41.01] [Speech Therapy (%BC): 41.01] [Other Outpatient Implant (%BC): 24.52] [IV Therapy (%BC): 41.01] [All Other OP (%BC): 41.01]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50] [All Other OP (%BC): 16.218]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 45.89] [Cardiac Cath (%BC): 45.89] [Lithotripsy (%BC): 45.89] [PTCA (%BC): 45.89] [Observation (%BC): 55.14] [Emergency Department (%BC): 55.14] [Other Cardiac Testing (%BC): 50.30] [EEG (%BC): 50.30] [Chemotherapy (%BC): 50.30] [Nuclear Medicine (%BC): 18.93] [Radiation Therapy  (%BC): 50.30] [CT OP Scan (%BC): 18.93] [MRI OP (%BC): 18.93] [Positron Emission Tomography (%BC): 18.93] [Radiology (%BC): 18.93] [Laboratory (%BC): 50.30] [Occupational Therapy (%BC): 50.30] [Physical Therapy (%BC): 50.30] [Speech Therapy (%BC): 50.30] [Other Outpatient Implant (%BC): 24.52] [IV Therapy (%BC): 50.30] [All Other OP (%BC): 50.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 27.6] [Cardiac Cath (%BC): 27.6] [Observation (%BC): 42.8] [Emergency Department (%BC): 42.8] [Occupational Therapy (%BC): 27.6] [Physical Therapy (%BC): 27.6] [Respiratory Services/Therapy  (%BC): 27.6] [Speech Therapy (%BC): 27.6] [All Other OP (%BC): 27.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":486.47,"10th_percentile":486.47,"90th_percentile":486.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 60.4] [Cardiac Cath (%BC): 60.4] [Observation (%BC): 53.7] [Emergency Department (%BC): 53.7] [Occupational Therapy (%BC): 60.4] [Physical Therapy (%BC): 60.4] [Respiratory Services/Therapy  (%BC): 60.4] [Speech Therapy (%BC): 60.4] [All Other OP (%BC): 60.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 3 Drug Administration","code_information":[{"code":"5693","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 33.9] [Cardiac Cath (%BC): 33.9] [Observation (%BC): 57.7] [Emergency Department (%BC): 57.7] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 33.9] [Occupational Therapy (%BC): 33.9] [Physical Therapy (%BC): 33.9] [Respiratory Services/Therapy  (%BC): 33.9] [Speech Therapy (%BC): 33.9] [All Other OP (%BC): 33.9]","count":"60","median_amount":6020.74,"10th_percentile":1826.94,"90th_percentile":13036.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"14","median_amount":406.71,"10th_percentile":178.27,"90th_percentile":700.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"26","median_amount":1142.87,"10th_percentile":744.67,"90th_percentile":1507.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Avmed","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.5,"count":"1 through 10","median_amount":18062.34,"10th_percentile":18062.34,"90th_percentile":18062.34},{"payer_name":"Baycare Plus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":869.93,"10th_percentile":869.93,"90th_percentile":869.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 30.92] [Cardiac Cath (%BC): 30.92] [Lithotripsy (%BC): 30.92] [PTCA (%BC): 30.92] [Observation (%BC): 47.84] [Emergency Department (%BC): 47.84] [Other Cardiac Testing (%BC): 41.01] [EEG (%BC): 41.01] [Chemotherapy (%BC): 41.01] [Nuclear Medicine (%BC): 15.94] [Radiation Therapy  (%BC): 41.01] [CT OP Scan (%BC): 15.94] [MRI OP (%BC): 15.94] [Positron Emission Tomography (%BC): 15.94] [Radiology (%BC): 15.94] [Laboratory (%BC): 41.01] [Occupational Therapy (%BC): 41.01] [Physical Therapy (%BC): 41.01] [Speech Therapy (%BC): 41.01] [Other Outpatient Implant (%BC): 24.52] [IV Therapy (%BC): 41.01] [All Other OP (%BC): 41.01]","count":"99","median_amount":6731.21,"10th_percentile":2780.33,"90th_percentile":12363.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50] [All Other OP (%BC): 16.218]","count":"1 through 10","median_amount":1059.3,"10th_percentile":885.62,"90th_percentile":1350.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 45.89] [Cardiac Cath (%BC): 45.89] [Lithotripsy (%BC): 45.89] [PTCA (%BC): 45.89] [Observation (%BC): 55.14] [Emergency Department (%BC): 55.14] [Other Cardiac Testing (%BC): 50.30] [EEG (%BC): 50.30] [Chemotherapy (%BC): 50.30] [Nuclear Medicine (%BC): 18.93] [Radiation Therapy  (%BC): 50.30] [CT OP Scan (%BC): 18.93] [MRI OP (%BC): 18.93] [Positron Emission Tomography (%BC): 18.93] [Radiology (%BC): 18.93] [Laboratory (%BC): 50.30] [Occupational Therapy (%BC): 50.30] [Physical Therapy (%BC): 50.30] [Speech Therapy (%BC): 50.30] [Other Outpatient Implant (%BC): 24.52] [IV Therapy (%BC): 50.30] [All Other OP (%BC): 50.30]","count":"1 through 10","median_amount":10898.75,"10th_percentile":10898.75,"90th_percentile":10898.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1219.4,"10th_percentile":855.69,"90th_percentile":1878.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 27.6] [Cardiac Cath (%BC): 27.6] [Observation (%BC): 42.8] [Emergency Department (%BC): 42.8] [Occupational Therapy (%BC): 27.6] [Physical Therapy (%BC): 27.6] [Respiratory Services/Therapy  (%BC): 27.6] [Speech Therapy (%BC): 27.6] [All Other OP (%BC): 27.6]","count":"1 through 10","median_amount":4712.95,"10th_percentile":4712.95,"90th_percentile":4712.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"First Health/Coventry","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"1 through 10","median_amount":1813.14,"10th_percentile":1813.14,"90th_percentile":1813.14},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"38","median_amount":478.27,"10th_percentile":165.77,"90th_percentile":716.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"40","median_amount":1084.94,"10th_percentile":674.02,"90th_percentile":1493.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1798.34,"10th_percentile":1672.43,"90th_percentile":2950.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"40","median_amount":387.29,"10th_percentile":279.55,"90th_percentile":704.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1374.01,"10th_percentile":1374.01,"90th_percentile":1375.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"121","median_amount":1837.85,"10th_percentile":1209.92,"90th_percentile":3076.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"74","median_amount":504.32,"10th_percentile":184.88,"90th_percentile":726.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 60.4] [Cardiac Cath (%BC): 60.4] [Observation (%BC): 53.7] [Emergency Department (%BC): 53.7] [Occupational Therapy (%BC): 60.4] [Physical Therapy (%BC): 60.4] [Respiratory Services/Therapy  (%BC): 60.4] [Speech Therapy (%BC): 60.4] [All Other OP (%BC): 60.4]","count":"25","median_amount":6088.97,"10th_percentile":3234.56,"90th_percentile":12381.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"36","median_amount":1146.85,"10th_percentile":846.51,"90th_percentile":1639.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":872.13,"10th_percentile":754.92,"90th_percentile":1501.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 1 Diagnostic Tests and Related Services","code_information":[{"code":"5721","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 33.9] [Cardiac Cath (%BC): 33.9] [Observation (%BC): 57.7] [Emergency Department (%BC): 57.7] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 33.9] [Occupational Therapy (%BC): 33.9] [Physical Therapy (%BC): 33.9] [Respiratory Services/Therapy  (%BC): 33.9] [Speech Therapy (%BC): 33.9] [All Other OP (%BC): 33.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Avmed","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Baycare Plus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 30.92] [Cardiac Cath (%BC): 30.92] [Lithotripsy (%BC): 30.92] [PTCA (%BC): 30.92] [Observation (%BC): 47.84] [Emergency Department (%BC): 47.84] [Other Cardiac Testing (%BC): 41.01] [EEG (%BC): 41.01] [Chemotherapy (%BC): 41.01] [Nuclear Medicine (%BC): 15.94] [Radiation Therapy  (%BC): 41.01] [CT OP Scan (%BC): 15.94] [MRI OP (%BC): 15.94] [Positron Emission Tomography (%BC): 15.94] [Radiology (%BC): 15.94] [Laboratory (%BC): 41.01] [Occupational Therapy (%BC): 41.01] [Physical Therapy (%BC): 41.01] [Speech Therapy (%BC): 41.01] [Other Outpatient Implant (%BC): 24.52] [IV Therapy (%BC): 41.01] [All Other OP (%BC): 41.01]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50] [All Other OP (%BC): 16.218]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 45.89] [Cardiac Cath (%BC): 45.89] [Lithotripsy (%BC): 45.89] [PTCA (%BC): 45.89] [Observation (%BC): 55.14] [Emergency Department (%BC): 55.14] [Other Cardiac Testing (%BC): 50.30] [EEG (%BC): 50.30] [Chemotherapy (%BC): 50.30] [Nuclear Medicine (%BC): 18.93] [Radiation Therapy  (%BC): 50.30] [CT OP Scan (%BC): 18.93] [MRI OP (%BC): 18.93] [Positron Emission Tomography (%BC): 18.93] [Radiology (%BC): 18.93] [Laboratory (%BC): 50.30] [Occupational Therapy (%BC): 50.30] [Physical Therapy (%BC): 50.30] [Speech Therapy (%BC): 50.30] [Other Outpatient Implant (%BC): 24.52] [IV Therapy (%BC): 50.30] [All Other OP (%BC): 50.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 27.6] [Cardiac Cath (%BC): 27.6] [Observation (%BC): 42.8] [Emergency Department (%BC): 42.8] [Occupational Therapy (%BC): 27.6] [Physical Therapy (%BC): 27.6] [Respiratory Services/Therapy  (%BC): 27.6] [Speech Therapy (%BC): 27.6] [All Other OP (%BC): 27.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1065.01,"10th_percentile":1065.01,"90th_percentile":1065.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 60.4] [Cardiac Cath (%BC): 60.4] [Observation (%BC): 53.7] [Emergency Department (%BC): 53.7] [Occupational Therapy (%BC): 60.4] [Physical Therapy (%BC): 60.4] [Respiratory Services/Therapy  (%BC): 60.4] [Speech Therapy (%BC): 60.4] [All Other OP (%BC): 60.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Diagnostic Tests and Related Services","code_information":[{"code":"5722","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 33.9] [Cardiac Cath (%BC): 33.9] [Observation (%BC): 57.7] [Emergency Department (%BC): 57.7] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 33.9] [Occupational Therapy (%BC): 33.9] [Physical Therapy (%BC): 33.9] [Respiratory Services/Therapy  (%BC): 33.9] [Speech Therapy (%BC): 33.9] [All Other OP (%BC): 33.9]","count":"1 through 10","median_amount":787.17,"10th_percentile":787.17,"90th_percentile":88467.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":320.58,"10th_percentile":320.58,"90th_percentile":320.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Avmed","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Baycare Plus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":312.58,"10th_percentile":312.58,"90th_percentile":312.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 30.92] [Cardiac Cath (%BC): 30.92] [Lithotripsy (%BC): 30.92] [PTCA (%BC): 30.92] [Observation (%BC): 47.84] [Emergency Department (%BC): 47.84] [Other Cardiac Testing (%BC): 41.01] [EEG (%BC): 41.01] [Chemotherapy (%BC): 41.01] [Nuclear Medicine (%BC): 15.94] [Radiation Therapy  (%BC): 41.01] [CT OP Scan (%BC): 15.94] [MRI OP (%BC): 15.94] [Positron Emission Tomography (%BC): 15.94] [Radiology (%BC): 15.94] [Laboratory (%BC): 41.01] [Occupational Therapy (%BC): 41.01] [Physical Therapy (%BC): 41.01] [Speech Therapy (%BC): 41.01] [Other Outpatient Implant (%BC): 24.52] [IV Therapy (%BC): 41.01] [All Other OP (%BC): 41.01]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50] [All Other OP (%BC): 16.218]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 45.89] [Cardiac Cath (%BC): 45.89] [Lithotripsy (%BC): 45.89] [PTCA (%BC): 45.89] [Observation (%BC): 55.14] [Emergency Department (%BC): 55.14] [Other Cardiac Testing (%BC): 50.30] [EEG (%BC): 50.30] [Chemotherapy (%BC): 50.30] [Nuclear Medicine (%BC): 18.93] [Radiation Therapy  (%BC): 50.30] [CT OP Scan (%BC): 18.93] [MRI OP (%BC): 18.93] [Positron Emission Tomography (%BC): 18.93] [Radiology (%BC): 18.93] [Laboratory (%BC): 50.30] [Occupational Therapy (%BC): 50.30] [Physical Therapy (%BC): 50.30] [Speech Therapy (%BC): 50.30] [Other Outpatient Implant (%BC): 24.52] [IV Therapy (%BC): 50.30] [All Other OP (%BC): 50.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 27.6] [Cardiac Cath (%BC): 27.6] [Observation (%BC): 42.8] [Emergency Department (%BC): 42.8] [Occupational Therapy (%BC): 27.6] [Physical Therapy (%BC): 27.6] [Respiratory Services/Therapy  (%BC): 27.6] [Speech Therapy (%BC): 27.6] [All Other OP (%BC): 27.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":338.44,"10th_percentile":338.44,"90th_percentile":338.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 60.4] [Cardiac Cath (%BC): 60.4] [Observation (%BC): 53.7] [Emergency Department (%BC): 53.7] [Occupational Therapy (%BC): 60.4] [Physical Therapy (%BC): 60.4] [Respiratory Services/Therapy  (%BC): 60.4] [Speech Therapy (%BC): 60.4] [All Other OP (%BC): 60.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1461.34,"10th_percentile":1461.34,"90th_percentile":1461.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 3 Minor Procedures","code_information":[{"code":"5733","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 33.9] [Cardiac Cath (%BC): 33.9] [Observation (%BC): 57.7] [Emergency Department (%BC): 57.7] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 33.9] [Occupational Therapy (%BC): 33.9] [Physical Therapy (%BC): 33.9] [Respiratory Services/Therapy  (%BC): 33.9] [Speech Therapy (%BC): 33.9] [All Other OP (%BC): 33.9]","count":"1 through 10","median_amount":689.92,"10th_percentile":689.92,"90th_percentile":689.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Avmed","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Baycare Plus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 30.92] [Cardiac Cath (%BC): 30.92] [Lithotripsy (%BC): 30.92] [PTCA (%BC): 30.92] [Observation (%BC): 47.84] [Emergency Department (%BC): 47.84] [Other Cardiac Testing (%BC): 41.01] [EEG (%BC): 41.01] [Chemotherapy (%BC): 41.01] [Nuclear Medicine (%BC): 15.94] [Radiation Therapy  (%BC): 41.01] [CT OP Scan (%BC): 15.94] [MRI OP (%BC): 15.94] [Positron Emission Tomography (%BC): 15.94] [Radiology (%BC): 15.94] [Laboratory (%BC): 41.01] [Occupational Therapy (%BC): 41.01] [Physical Therapy (%BC): 41.01] [Speech Therapy (%BC): 41.01] [Other Outpatient Implant (%BC): 24.52] [IV Therapy (%BC): 41.01] [All Other OP (%BC): 41.01]","count":"1 through 10","median_amount":299.99,"10th_percentile":299.99,"90th_percentile":299.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50] [All Other OP (%BC): 16.218]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 45.89] [Cardiac Cath (%BC): 45.89] [Lithotripsy (%BC): 45.89] [PTCA (%BC): 45.89] [Observation (%BC): 55.14] [Emergency Department (%BC): 55.14] [Other Cardiac Testing (%BC): 50.30] [EEG (%BC): 50.30] [Chemotherapy (%BC): 50.30] [Nuclear Medicine (%BC): 18.93] [Radiation Therapy  (%BC): 50.30] [CT OP Scan (%BC): 18.93] [MRI OP (%BC): 18.93] [Positron Emission Tomography (%BC): 18.93] [Radiology (%BC): 18.93] [Laboratory (%BC): 50.30] [Occupational Therapy (%BC): 50.30] [Physical Therapy (%BC): 50.30] [Speech Therapy (%BC): 50.30] [Other Outpatient Implant (%BC): 24.52] [IV Therapy (%BC): 50.30] [All Other OP (%BC): 50.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 27.6] [Cardiac Cath (%BC): 27.6] [Observation (%BC): 42.8] [Emergency Department (%BC): 42.8] [Occupational Therapy (%BC): 27.6] [Physical Therapy (%BC): 27.6] [Respiratory Services/Therapy  (%BC): 27.6] [Speech Therapy (%BC): 27.6] [All Other OP (%BC): 27.6]","count":"1 through 10","median_amount":210.67,"10th_percentile":210.67,"90th_percentile":210.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"First Health/Coventry","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":25.13,"10th_percentile":25.13,"90th_percentile":25.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":58.67,"10th_percentile":58.67,"90th_percentile":58.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":108.87,"10th_percentile":108.87,"90th_percentile":108.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":132.36,"10th_percentile":132.36,"90th_percentile":132.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 60.4] [Cardiac Cath (%BC): 60.4] [Observation (%BC): 53.7] [Emergency Department (%BC): 53.7] [Occupational Therapy (%BC): 60.4] [Physical Therapy (%BC): 60.4] [Respiratory Services/Therapy  (%BC): 60.4] [Speech Therapy (%BC): 60.4] [All Other OP (%BC): 60.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":61.6,"10th_percentile":61.6,"90th_percentile":61.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 4 Minor Procedures","code_information":[{"code":"5734","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 33.9] [Cardiac Cath (%BC): 33.9] [Observation (%BC): 57.7] [Emergency Department (%BC): 57.7] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 33.9] [Occupational Therapy (%BC): 33.9] [Physical Therapy (%BC): 33.9] [Respiratory Services/Therapy  (%BC): 33.9] [Speech Therapy (%BC): 33.9] [All Other OP (%BC): 33.9]","count":"17","median_amount":404.12,"10th_percentile":238.24,"90th_percentile":674.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":131.88,"10th_percentile":131.88,"90th_percentile":131.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Avmed","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Baycare Plus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 30.92] [Cardiac Cath (%BC): 30.92] [Lithotripsy (%BC): 30.92] [PTCA (%BC): 30.92] [Observation (%BC): 47.84] [Emergency Department (%BC): 47.84] [Other Cardiac Testing (%BC): 41.01] [EEG (%BC): 41.01] [Chemotherapy (%BC): 41.01] [Nuclear Medicine (%BC): 15.94] [Radiation Therapy  (%BC): 41.01] [CT OP Scan (%BC): 15.94] [MRI OP (%BC): 15.94] [Positron Emission Tomography (%BC): 15.94] [Radiology (%BC): 15.94] [Laboratory (%BC): 41.01] [Occupational Therapy (%BC): 41.01] [Physical Therapy (%BC): 41.01] [Speech Therapy (%BC): 41.01] [Other Outpatient Implant (%BC): 24.52] [IV Therapy (%BC): 41.01] [All Other OP (%BC): 41.01]","count":"15","median_amount":353.52,"10th_percentile":248.42,"90th_percentile":757.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50] [All Other OP (%BC): 16.218]","count":"1 through 10","median_amount":131.98,"10th_percentile":131.98,"90th_percentile":131.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 45.89] [Cardiac Cath (%BC): 45.89] [Lithotripsy (%BC): 45.89] [PTCA (%BC): 45.89] [Observation (%BC): 55.14] [Emergency Department (%BC): 55.14] [Other Cardiac Testing (%BC): 50.30] [EEG (%BC): 50.30] [Chemotherapy (%BC): 50.30] [Nuclear Medicine (%BC): 18.93] [Radiation Therapy  (%BC): 50.30] [CT OP Scan (%BC): 18.93] [MRI OP (%BC): 18.93] [Positron Emission Tomography (%BC): 18.93] [Radiology (%BC): 18.93] [Laboratory (%BC): 50.30] [Occupational Therapy (%BC): 50.30] [Physical Therapy (%BC): 50.30] [Speech Therapy (%BC): 50.30] [Other Outpatient Implant (%BC): 24.52] [IV Therapy (%BC): 50.30] [All Other OP (%BC): 50.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 27.6] [Cardiac Cath (%BC): 27.6] [Observation (%BC): 42.8] [Emergency Department (%BC): 42.8] [Occupational Therapy (%BC): 27.6] [Physical Therapy (%BC): 27.6] [Respiratory Services/Therapy  (%BC): 27.6] [Speech Therapy (%BC): 27.6] [All Other OP (%BC): 27.6]","count":"12","median_amount":469.78,"10th_percentile":208.87,"90th_percentile":727.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"First Health/Coventry","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":12.28,"10th_percentile":12.28,"90th_percentile":12.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":127.8,"10th_percentile":126.8,"90th_percentile":129.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":236.27,"10th_percentile":236.27,"90th_percentile":236.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":14.09,"10th_percentile":14.09,"90th_percentile":14.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":134.41,"10th_percentile":134.41,"90th_percentile":134.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":287.25,"10th_percentile":287.25,"90th_percentile":287.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":12.53,"10th_percentile":12.53,"90th_percentile":12.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 60.4] [Cardiac Cath (%BC): 60.4] [Observation (%BC): 53.7] [Emergency Department (%BC): 53.7] [Occupational Therapy (%BC): 60.4] [Physical Therapy (%BC): 60.4] [Respiratory Services/Therapy  (%BC): 60.4] [Speech Therapy (%BC): 60.4] [All Other OP (%BC): 60.4]","count":"1 through 10","median_amount":996.3,"10th_percentile":996.3,"90th_percentile":996.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":135.86,"10th_percentile":133.14,"90th_percentile":135.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Resuscitation and Cardioversion","code_information":[{"code":"5781","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 33.9] [Cardiac Cath (%BC): 33.9] [Observation (%BC): 57.7] [Emergency Department (%BC): 57.7] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 33.9] [Occupational Therapy (%BC): 33.9] [Physical Therapy (%BC): 33.9] [Respiratory Services/Therapy  (%BC): 33.9] [Speech Therapy (%BC): 33.9] [All Other OP (%BC): 33.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Avmed","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Baycare Plus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 30.92] [Cardiac Cath (%BC): 30.92] [Lithotripsy (%BC): 30.92] [PTCA (%BC): 30.92] [Observation (%BC): 47.84] [Emergency Department (%BC): 47.84] [Other Cardiac Testing (%BC): 41.01] [EEG (%BC): 41.01] [Chemotherapy (%BC): 41.01] [Nuclear Medicine (%BC): 15.94] [Radiation Therapy  (%BC): 41.01] [CT OP Scan (%BC): 15.94] [MRI OP (%BC): 15.94] [Positron Emission Tomography (%BC): 15.94] [Radiology (%BC): 15.94] [Laboratory (%BC): 41.01] [Occupational Therapy (%BC): 41.01] [Physical Therapy (%BC): 41.01] [Speech Therapy (%BC): 41.01] [Other Outpatient Implant (%BC): 24.52] [IV Therapy (%BC): 41.01] [All Other OP (%BC): 41.01]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50] [All Other OP (%BC): 16.218]","count":"1 through 10","median_amount":1231.37,"10th_percentile":1231.37,"90th_percentile":1231.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 45.89] [Cardiac Cath (%BC): 45.89] [Lithotripsy (%BC): 45.89] [PTCA (%BC): 45.89] [Observation (%BC): 55.14] [Emergency Department (%BC): 55.14] [Other Cardiac Testing (%BC): 50.30] [EEG (%BC): 50.30] [Chemotherapy (%BC): 50.30] [Nuclear Medicine (%BC): 18.93] [Radiation Therapy  (%BC): 50.30] [CT OP Scan (%BC): 18.93] [MRI OP (%BC): 18.93] [Positron Emission Tomography (%BC): 18.93] [Radiology (%BC): 18.93] [Laboratory (%BC): 50.30] [Occupational Therapy (%BC): 50.30] [Physical Therapy (%BC): 50.30] [Speech Therapy (%BC): 50.30] [Other Outpatient Implant (%BC): 24.52] [IV Therapy (%BC): 50.30] [All Other OP (%BC): 50.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 27.6] [Cardiac Cath (%BC): 27.6] [Observation (%BC): 42.8] [Emergency Department (%BC): 42.8] [Occupational Therapy (%BC): 27.6] [Physical Therapy (%BC): 27.6] [Respiratory Services/Therapy  (%BC): 27.6] [Speech Therapy (%BC): 27.6] [All Other OP (%BC): 27.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2204.39,"10th_percentile":2204.39,"90th_percentile":2204.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2680.03,"10th_percentile":2680.03,"90th_percentile":2680.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 60.4] [Cardiac Cath (%BC): 60.4] [Observation (%BC): 53.7] [Emergency Department (%BC): 53.7] [Occupational Therapy (%BC): 60.4] [Physical Therapy (%BC): 60.4] [Respiratory Services/Therapy  (%BC): 60.4] [Speech Therapy (%BC): 60.4] [All Other OP (%BC): 60.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Health and Behavior Services","code_information":[{"code":"5821","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 33.9] [Cardiac Cath (%BC): 33.9] [Observation (%BC): 57.7] [Emergency Department (%BC): 57.7] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 33.9] [Occupational Therapy (%BC): 33.9] [Physical Therapy (%BC): 33.9] [Respiratory Services/Therapy  (%BC): 33.9] [Speech Therapy (%BC): 33.9] [All Other OP (%BC): 33.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Avmed","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Baycare Plus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 30.92] [Cardiac Cath (%BC): 30.92] [Lithotripsy (%BC): 30.92] [PTCA (%BC): 30.92] [Observation (%BC): 47.84] [Emergency Department (%BC): 47.84] [Other Cardiac Testing (%BC): 41.01] [EEG (%BC): 41.01] [Chemotherapy (%BC): 41.01] [Nuclear Medicine (%BC): 15.94] [Radiation Therapy  (%BC): 41.01] [CT OP Scan (%BC): 15.94] [MRI OP (%BC): 15.94] [Positron Emission Tomography (%BC): 15.94] [Radiology (%BC): 15.94] [Laboratory (%BC): 41.01] [Occupational Therapy (%BC): 41.01] [Physical Therapy (%BC): 41.01] [Speech Therapy (%BC): 41.01] [Other Outpatient Implant (%BC): 24.52] [IV Therapy (%BC): 41.01] [All Other OP (%BC): 41.01]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50] [All Other OP (%BC): 16.218]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 45.89] [Cardiac Cath (%BC): 45.89] [Lithotripsy (%BC): 45.89] [PTCA (%BC): 45.89] [Observation (%BC): 55.14] [Emergency Department (%BC): 55.14] [Other Cardiac Testing (%BC): 50.30] [EEG (%BC): 50.30] [Chemotherapy (%BC): 50.30] [Nuclear Medicine (%BC): 18.93] [Radiation Therapy  (%BC): 50.30] [CT OP Scan (%BC): 18.93] [MRI OP (%BC): 18.93] [Positron Emission Tomography (%BC): 18.93] [Radiology (%BC): 18.93] [Laboratory (%BC): 50.30] [Occupational Therapy (%BC): 50.30] [Physical Therapy (%BC): 50.30] [Speech Therapy (%BC): 50.30] [Other Outpatient Implant (%BC): 24.52] [IV Therapy (%BC): 50.30] [All Other OP (%BC): 50.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 27.6] [Cardiac Cath (%BC): 27.6] [Observation (%BC): 42.8] [Emergency Department (%BC): 42.8] [Occupational Therapy (%BC): 27.6] [Physical Therapy (%BC): 27.6] [Respiratory Services/Therapy  (%BC): 27.6] [Speech Therapy (%BC): 27.6] [All Other OP (%BC): 27.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1276.3,"10th_percentile":1276.3,"90th_percentile":1276.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 60.4] [Cardiac Cath (%BC): 60.4] [Observation (%BC): 53.7] [Emergency Department (%BC): 53.7] [Occupational Therapy (%BC): 60.4] [Physical Therapy (%BC): 60.4] [Respiratory Services/Therapy  (%BC): 60.4] [Speech Therapy (%BC): 60.4] [All Other OP (%BC): 60.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"RBC leukocytes reduced","code_information":[{"code":"9512","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 33.9] [Cardiac Cath (%BC): 33.9] [Observation (%BC): 57.7] [Emergency Department (%BC): 57.7] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 33.9] [Occupational Therapy (%BC): 33.9] [Physical Therapy (%BC): 33.9] [Respiratory Services/Therapy  (%BC): 33.9] [Speech Therapy (%BC): 33.9] [All Other OP (%BC): 33.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Avmed","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Baycare Plus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 30.92] [Cardiac Cath (%BC): 30.92] [Lithotripsy (%BC): 30.92] [PTCA (%BC): 30.92] [Observation (%BC): 47.84] [Emergency Department (%BC): 47.84] [Other Cardiac Testing (%BC): 41.01] [EEG (%BC): 41.01] [Chemotherapy (%BC): 41.01] [Nuclear Medicine (%BC): 15.94] [Radiation Therapy  (%BC): 41.01] [CT OP Scan (%BC): 15.94] [MRI OP (%BC): 15.94] [Positron Emission Tomography (%BC): 15.94] [Radiology (%BC): 15.94] [Laboratory (%BC): 41.01] [Occupational Therapy (%BC): 41.01] [Physical Therapy (%BC): 41.01] [Speech Therapy (%BC): 41.01] [Other Outpatient Implant (%BC): 24.52] [IV Therapy (%BC): 41.01] [All Other OP (%BC): 41.01]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50] [All Other OP (%BC): 16.218]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 45.89] [Cardiac Cath (%BC): 45.89] [Lithotripsy (%BC): 45.89] [PTCA (%BC): 45.89] [Observation (%BC): 55.14] [Emergency Department (%BC): 55.14] [Other Cardiac Testing (%BC): 50.30] [EEG (%BC): 50.30] [Chemotherapy (%BC): 50.30] [Nuclear Medicine (%BC): 18.93] [Radiation Therapy  (%BC): 50.30] [CT OP Scan (%BC): 18.93] [MRI OP (%BC): 18.93] [Positron Emission Tomography (%BC): 18.93] [Radiology (%BC): 18.93] [Laboratory (%BC): 50.30] [Occupational Therapy (%BC): 50.30] [Physical Therapy (%BC): 50.30] [Speech Therapy (%BC): 50.30] [Other Outpatient Implant (%BC): 24.52] [IV Therapy (%BC): 50.30] [All Other OP (%BC): 50.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 27.6] [Cardiac Cath (%BC): 27.6] [Observation (%BC): 42.8] [Emergency Department (%BC): 42.8] [Occupational Therapy (%BC): 27.6] [Physical Therapy (%BC): 27.6] [Respiratory Services/Therapy  (%BC): 27.6] [Speech Therapy (%BC): 27.6] [All Other OP (%BC): 27.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":4397.21,"10th_percentile":4397.21,"90th_percentile":4397.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":945.17,"10th_percentile":945.17,"90th_percentile":945.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 60.4] [Cardiac Cath (%BC): 60.4] [Observation (%BC): 53.7] [Emergency Department (%BC): 53.7] [Occupational Therapy (%BC): 60.4] [Physical Therapy (%BC): 60.4] [Respiratory Services/Therapy  (%BC): 60.4] [Speech Therapy (%BC): 60.4] [All Other OP (%BC): 60.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Non-OPPS Clinic Services","code_information":[{"code":"N700","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 33.9] [Cardiac Cath (%BC): 33.9] [Observation (%BC): 57.7] [Emergency Department (%BC): 57.7] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 33.9] [Occupational Therapy (%BC): 33.9] [Physical Therapy (%BC): 33.9] [Respiratory Services/Therapy  (%BC): 33.9] [Speech Therapy (%BC): 33.9] [All Other OP (%BC): 33.9]","count":"1 through 10","median_amount":134.43,"10th_percentile":134.43,"90th_percentile":134.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Avmed","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Baycare Plus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 30.92] [Cardiac Cath (%BC): 30.92] [Lithotripsy (%BC): 30.92] [PTCA (%BC): 30.92] [Observation (%BC): 47.84] [Emergency Department (%BC): 47.84] [Other Cardiac Testing (%BC): 41.01] [EEG (%BC): 41.01] [Chemotherapy (%BC): 41.01] [Nuclear Medicine (%BC): 15.94] [Radiation Therapy  (%BC): 41.01] [CT OP Scan (%BC): 15.94] [MRI OP (%BC): 15.94] [Positron Emission Tomography (%BC): 15.94] [Radiology (%BC): 15.94] [Laboratory (%BC): 41.01] [Occupational Therapy (%BC): 41.01] [Physical Therapy (%BC): 41.01] [Speech Therapy (%BC): 41.01] [Other Outpatient Implant (%BC): 24.52] [IV Therapy (%BC): 41.01] [All Other OP (%BC): 41.01]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50] [All Other OP (%BC): 16.218]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 45.89] [Cardiac Cath (%BC): 45.89] [Lithotripsy (%BC): 45.89] [PTCA (%BC): 45.89] [Observation (%BC): 55.14] [Emergency Department (%BC): 55.14] [Other Cardiac Testing (%BC): 50.30] [EEG (%BC): 50.30] [Chemotherapy (%BC): 50.30] [Nuclear Medicine (%BC): 18.93] [Radiation Therapy  (%BC): 50.30] [CT OP Scan (%BC): 18.93] [MRI OP (%BC): 18.93] [Positron Emission Tomography (%BC): 18.93] [Radiology (%BC): 18.93] [Laboratory (%BC): 50.30] [Occupational Therapy (%BC): 50.30] [Physical Therapy (%BC): 50.30] [Speech Therapy (%BC): 50.30] [Other Outpatient Implant (%BC): 24.52] [IV Therapy (%BC): 50.30] [All Other OP (%BC): 50.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 27.6] [Cardiac Cath (%BC): 27.6] [Observation (%BC): 42.8] [Emergency Department (%BC): 42.8] [Occupational Therapy (%BC): 27.6] [Physical Therapy (%BC): 27.6] [Respiratory Services/Therapy  (%BC): 27.6] [Speech Therapy (%BC): 27.6] [All Other OP (%BC): 27.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 60.4] [Cardiac Cath (%BC): 60.4] [Observation (%BC): 53.7] [Emergency Department (%BC): 53.7] [Occupational Therapy (%BC): 60.4] [Physical Therapy (%BC): 60.4] [Respiratory Services/Therapy  (%BC): 60.4] [Speech Therapy (%BC): 60.4] [All Other OP (%BC): 60.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Clinical Diagnostic Lab Services","code_information":[{"code":"N800","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 33.9] [Cardiac Cath (%BC): 33.9] [Observation (%BC): 57.7] [Emergency Department (%BC): 57.7] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 33.9] [Occupational Therapy (%BC): 33.9] [Physical Therapy (%BC): 33.9] [Respiratory Services/Therapy  (%BC): 33.9] [Speech Therapy (%BC): 33.9] [All Other OP (%BC): 33.9]","count":"33","median_amount":526.38,"10th_percentile":99.36,"90th_percentile":1017.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":22.51,"10th_percentile":19.35,"90th_percentile":34.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":28.32,"10th_percentile":28.32,"90th_percentile":28.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Avmed","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Baycare Plus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":25.32,"10th_percentile":25.32,"90th_percentile":25.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 30.92] [Cardiac Cath (%BC): 30.92] [Lithotripsy (%BC): 30.92] [PTCA (%BC): 30.92] [Observation (%BC): 47.84] [Emergency Department (%BC): 47.84] [Other Cardiac Testing (%BC): 41.01] [EEG (%BC): 41.01] [Chemotherapy (%BC): 41.01] [Nuclear Medicine (%BC): 15.94] [Radiation Therapy  (%BC): 41.01] [CT OP Scan (%BC): 15.94] [MRI OP (%BC): 15.94] [Positron Emission Tomography (%BC): 15.94] [Radiology (%BC): 15.94] [Laboratory (%BC): 41.01] [Occupational Therapy (%BC): 41.01] [Physical Therapy (%BC): 41.01] [Speech Therapy (%BC): 41.01] [Other Outpatient Implant (%BC): 24.52] [IV Therapy (%BC): 41.01] [All Other OP (%BC): 41.01]","count":"15","median_amount":451.19,"10th_percentile":353.22,"90th_percentile":1443.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50] [All Other OP (%BC): 16.218]","count":"1 through 10","median_amount":36.34,"10th_percentile":36.34,"90th_percentile":36.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 45.89] [Cardiac Cath (%BC): 45.89] [Lithotripsy (%BC): 45.89] [PTCA (%BC): 45.89] [Observation (%BC): 55.14] [Emergency Department (%BC): 55.14] [Other Cardiac Testing (%BC): 50.30] [EEG (%BC): 50.30] [Chemotherapy (%BC): 50.30] [Nuclear Medicine (%BC): 18.93] [Radiation Therapy  (%BC): 50.30] [CT OP Scan (%BC): 18.93] [MRI OP (%BC): 18.93] [Positron Emission Tomography (%BC): 18.93] [Radiology (%BC): 18.93] [Laboratory (%BC): 50.30] [Occupational Therapy (%BC): 50.30] [Physical Therapy (%BC): 50.30] [Speech Therapy (%BC): 50.30] [Other Outpatient Implant (%BC): 24.52] [IV Therapy (%BC): 50.30] [All Other OP (%BC): 50.30]","count":"1 through 10","median_amount":1178.1,"10th_percentile":1178.1,"90th_percentile":1178.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":26.27,"10th_percentile":26.27,"90th_percentile":26.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 27.6] [Cardiac Cath (%BC): 27.6] [Observation (%BC): 42.8] [Emergency Department (%BC): 42.8] [Occupational Therapy (%BC): 27.6] [Physical Therapy (%BC): 27.6] [Respiratory Services/Therapy  (%BC): 27.6] [Speech Therapy (%BC): 27.6] [All Other OP (%BC): 27.6]","count":"14","median_amount":352.56,"10th_percentile":231.78,"90th_percentile":981.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"First Health/Coventry","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":7.75,"10th_percentile":7.75,"90th_percentile":7.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":28.31,"10th_percentile":28.31,"90th_percentile":60.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":29.64,"10th_percentile":29.64,"90th_percentile":29.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":13.65,"10th_percentile":7.9,"90th_percentile":43.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":57.98,"10th_percentile":36.03,"90th_percentile":137.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":4.32,"10th_percentile":3.12,"90th_percentile":60.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 60.4] [Cardiac Cath (%BC): 60.4] [Observation (%BC): 53.7] [Emergency Department (%BC): 53.7] [Occupational Therapy (%BC): 60.4] [Physical Therapy (%BC): 60.4] [Respiratory Services/Therapy  (%BC): 60.4] [Speech Therapy (%BC): 60.4] [All Other OP (%BC): 60.4]","count":"1 through 10","median_amount":1946.62,"10th_percentile":1946.62,"90th_percentile":1946.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":21.54,"10th_percentile":17.04,"90th_percentile":128.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Therapy Services","code_information":[{"code":"N801","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 33.9] [Cardiac Cath (%BC): 33.9] [Observation (%BC): 57.7] [Emergency Department (%BC): 57.7] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 33.9] [Occupational Therapy (%BC): 33.9] [Physical Therapy (%BC): 33.9] [Respiratory Services/Therapy  (%BC): 33.9] [Speech Therapy (%BC): 33.9] [All Other OP (%BC): 33.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Avmed","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Baycare Plus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 30.92] [Cardiac Cath (%BC): 30.92] [Lithotripsy (%BC): 30.92] [PTCA (%BC): 30.92] [Observation (%BC): 47.84] [Emergency Department (%BC): 47.84] [Other Cardiac Testing (%BC): 41.01] [EEG (%BC): 41.01] [Chemotherapy (%BC): 41.01] [Nuclear Medicine (%BC): 15.94] [Radiation Therapy  (%BC): 41.01] [CT OP Scan (%BC): 15.94] [MRI OP (%BC): 15.94] [Positron Emission Tomography (%BC): 15.94] [Radiology (%BC): 15.94] [Laboratory (%BC): 41.01] [Occupational Therapy (%BC): 41.01] [Physical Therapy (%BC): 41.01] [Speech Therapy (%BC): 41.01] [Other Outpatient Implant (%BC): 24.52] [IV Therapy (%BC): 41.01] [All Other OP (%BC): 41.01]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50] [All Other OP (%BC): 16.218]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 45.89] [Cardiac Cath (%BC): 45.89] [Lithotripsy (%BC): 45.89] [PTCA (%BC): 45.89] [Observation (%BC): 55.14] [Emergency Department (%BC): 55.14] [Other Cardiac Testing (%BC): 50.30] [EEG (%BC): 50.30] [Chemotherapy (%BC): 50.30] [Nuclear Medicine (%BC): 18.93] [Radiation Therapy  (%BC): 50.30] [CT OP Scan (%BC): 18.93] [MRI OP (%BC): 18.93] [Positron Emission Tomography (%BC): 18.93] [Radiology (%BC): 18.93] [Laboratory (%BC): 50.30] [Occupational Therapy (%BC): 50.30] [Physical Therapy (%BC): 50.30] [Speech Therapy (%BC): 50.30] [Other Outpatient Implant (%BC): 24.52] [IV Therapy (%BC): 50.30] [All Other OP (%BC): 50.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 27.6] [Cardiac Cath (%BC): 27.6] [Observation (%BC): 42.8] [Emergency Department (%BC): 42.8] [Occupational Therapy (%BC): 27.6] [Physical Therapy (%BC): 27.6] [Respiratory Services/Therapy  (%BC): 27.6] [Speech Therapy (%BC): 27.6] [All Other OP (%BC): 27.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"48","median_amount":46.35,"10th_percentile":23.18,"90th_percentile":164.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 60.4] [Cardiac Cath (%BC): 60.4] [Observation (%BC): 53.7] [Emergency Department (%BC): 53.7] [Occupational Therapy (%BC): 60.4] [Physical Therapy (%BC): 60.4] [Respiratory Services/Therapy  (%BC): 60.4] [Speech Therapy (%BC): 60.4] [All Other OP (%BC): 60.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Observation, Other","code_information":[{"code":"N811","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 33.9] [Cardiac Cath (%BC): 33.9] [Observation (%BC): 57.7] [Emergency Department (%BC): 57.7] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 33.9] [Occupational Therapy (%BC): 33.9] [Physical Therapy (%BC): 33.9] [Respiratory Services/Therapy  (%BC): 33.9] [Speech Therapy (%BC): 33.9] [All Other OP (%BC): 33.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Avmed","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Baycare Plus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 30.92] [Cardiac Cath (%BC): 30.92] [Lithotripsy (%BC): 30.92] [PTCA (%BC): 30.92] [Observation (%BC): 47.84] [Emergency Department (%BC): 47.84] [Other Cardiac Testing (%BC): 41.01] [EEG (%BC): 41.01] [Chemotherapy (%BC): 41.01] [Nuclear Medicine (%BC): 15.94] [Radiation Therapy  (%BC): 41.01] [CT OP Scan (%BC): 15.94] [MRI OP (%BC): 15.94] [Positron Emission Tomography (%BC): 15.94] [Radiology (%BC): 15.94] [Laboratory (%BC): 41.01] [Occupational Therapy (%BC): 41.01] [Physical Therapy (%BC): 41.01] [Speech Therapy (%BC): 41.01] [Other Outpatient Implant (%BC): 24.52] [IV Therapy (%BC): 41.01] [All Other OP (%BC): 41.01]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50] [All Other OP (%BC): 16.218]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 45.89] [Cardiac Cath (%BC): 45.89] [Lithotripsy (%BC): 45.89] [PTCA (%BC): 45.89] [Observation (%BC): 55.14] [Emergency Department (%BC): 55.14] [Other Cardiac Testing (%BC): 50.30] [EEG (%BC): 50.30] [Chemotherapy (%BC): 50.30] [Nuclear Medicine (%BC): 18.93] [Radiation Therapy  (%BC): 50.30] [CT OP Scan (%BC): 18.93] [MRI OP (%BC): 18.93] [Positron Emission Tomography (%BC): 18.93] [Radiology (%BC): 18.93] [Laboratory (%BC): 50.30] [Occupational Therapy (%BC): 50.30] [Physical Therapy (%BC): 50.30] [Speech Therapy (%BC): 50.30] [Other Outpatient Implant (%BC): 24.52] [IV Therapy (%BC): 50.30] [All Other OP (%BC): 50.30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 27.6] [Cardiac Cath (%BC): 27.6] [Observation (%BC): 42.8] [Emergency Department (%BC): 42.8] [Occupational Therapy (%BC): 27.6] [Physical Therapy (%BC): 27.6] [Respiratory Services/Therapy  (%BC): 27.6] [Speech Therapy (%BC): 27.6] [All Other OP (%BC): 27.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health/Coventry","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 60.4] [Cardiac Cath (%BC): 60.4] [Observation (%BC): 53.7] [Emergency Department (%BC): 53.7] [Occupational Therapy (%BC): 60.4] [Physical Therapy (%BC): 60.4] [Respiratory Services/Therapy  (%BC): 60.4] [Speech Therapy (%BC): 60.4] [All Other OP (%BC): 60.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":146.54,"10th_percentile":146.54,"90th_percentile":146.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Bone marrow transplant","code_information":[{"code":"009","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hyphema","code_information":[{"code":"043","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute Major Eye Infections","code_information":[{"code":"044","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Neurological eye disorders","code_information":[{"code":"045","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Disorders of the Eye Age >17 w CC","code_information":[{"code":"046","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Disorders of the Eye Age >17 w/o CC","code_information":[{"code":"047","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Disorders of the Eye Age 0-17","code_information":[{"code":"048","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Head & Neck Procedures","code_information":[{"code":"049","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Sialoadenectomy","code_information":[{"code":"050","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Salivary Gland Procedures Except Sialoadenectomy","code_information":[{"code":"051","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hypertensive Encephalopathy With Mcc","code_information":[{"code":"077","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hypertensive Encephalopathy With Cc","code_information":[{"code":"078","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hypertensive Encephalopathy Without Cc/Mcc","code_information":[{"code":"079","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Valve & Oth Major Cardiothoracic Proc w Cardiac Cath","code_information":[{"code":"104","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Valve & Oth Major Cardiothoracic Proc w/o Cardiac Cath","code_information":[{"code":"105","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Coronary Bypass w PTCA","code_information":[{"code":"106","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"No Longer Valid","code_information":[{"code":"107","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Cardiothoracic Procedures","code_information":[{"code":"108","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"No Longer Valid","code_information":[{"code":"109","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Cardiovascular Procedures w CC","code_information":[{"code":"110","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Cardiovascular Procedures w/o CC","code_information":[{"code":"111","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"No Longer Valid","code_information":[{"code":"112","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Pacemaker Device Replacement","code_information":[{"code":"118","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Vein ligation & stripping","code_information":[{"code":"119","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other circulatory system O.R. procedures","code_information":[{"code":"120","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute & Subacute Endocarditis","code_information":[{"code":"126","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Heart Failure & Shock","code_information":[{"code":"127","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Deep Vein Thrombophlebitis","code_information":[{"code":"128","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Head & Neck Procedures W Cc/Mcc Or Major Device","code_information":[{"code":"129","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Head & Neck Procedures W/O Cc/Mcc","code_information":[{"code":"130","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cranial/Facial Procedures W Cc/Mcc","code_information":[{"code":"131","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cranial/Facial Procedures W/O Cc/Mcc","code_information":[{"code":"132","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Ear, Nose, Mouth & Throat O.R. Procedures W Cc/Mcc","code_information":[{"code":"133","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Ear, Nose, Mouth & Throat O.R. Procedures W/O Cc/Mcc","code_information":[{"code":"134","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hernia Procedures Except Inguinal & Femoral Age >17 w/o CC","code_information":[{"code":"160","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Inguinal & Femoral Hernia Procedures Age >17 w CC","code_information":[{"code":"161","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Inguinal & Femoral Hernia Procedures Age >17 w/o CC","code_information":[{"code":"162","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Mouth Procedures w/o CC","code_information":[{"code":"169","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Digestive System O.R. Procedures w/o CC","code_information":[{"code":"171","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"G.I. hemorrhage w CC","code_information":[{"code":"174","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hip & Femur Procedures Except Major Joint Age >17 w CC","code_information":[{"code":"210","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hip & Femur Procedures Except Major Joint Age >17 w/o CC","code_information":[{"code":"211","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"No Longer Valid","code_information":[{"code":"214","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock With Mcc","code_information":[{"code":"222","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock Without Mcc","code_information":[{"code":"223","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock With Mcc","code_information":[{"code":"224","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock Without Mcc","code_information":[{"code":"225","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Defibrillator Implant Without Cardiac Catheterization With Mcc","code_information":[{"code":"226","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Defibrillator Implant Without Cardiac Catheterization Without Mcc","code_information":[{"code":"227","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other cardiothoracic procedures w/o CC/MCC","code_information":[{"code":"230","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major cardiovasc procedures w MCC","code_information":[{"code":"237","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major cardiovasc procedures w/o MCC","code_information":[{"code":"238","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Percutaneous Cardiovascular Procedures With Drug-Eluting Stent With Mcc Or 4+ Arteries Or Stents","code_information":[{"code":"246","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Percutaneous Cardiovascular Procedures With Drug-Eluting Stent Without Mcc","code_information":[{"code":"247","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent With Mcc Or 4+ Arteries Or Stents","code_information":[{"code":"248","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent Without Mcc","code_information":[{"code":"249","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Deep Vein Thrombophlebitis With Cc/Mcc","code_information":[{"code":"294","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Deep Vein Thrombophlebitis Without Cc/Mcc","code_information":[{"code":"295","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Appendectomy With Complicated Principal Diagnosis With Mcc","code_information":[{"code":"338","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Appendectomy With Complicated Principal Diagnosis With Cc","code_information":[{"code":"339","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Appendectomy With Complicated Principal Diagnosis Without Cc/Mcc","code_information":[{"code":"340","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Appendectomy Without Complicated Principal Diagnosis With Mcc","code_information":[{"code":"341","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Appendectomy Without Complicated Principal Diagnosis With Cc","code_information":[{"code":"342","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Appendectomy Without Complicated Principal Diagnosis Without Cc/Mcc","code_information":[{"code":"343","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Laparoscopy & Incisional Tubal Interruption","code_information":[{"code":"361","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Endoscopic Tubal Interruption","code_information":[{"code":"362","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"D&C, Conization & Radio-Implant, for Malignancy","code_information":[{"code":"363","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"D&C, Conization Except for Malignancy","code_information":[{"code":"364","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Female Reproductive System O.R. Procedures","code_information":[{"code":"365","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Malignancy, female reproductive system w CC","code_information":[{"code":"366","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Malignancy, Female Reproductive System w/o CC","code_information":[{"code":"367","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Red Blood Cell Disorders Age 0-17","code_information":[{"code":"396","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"No Longer Valid","code_information":[{"code":"400","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lymphoma & non-acute leukemia w other O.R. proc w CC","code_information":[{"code":"401","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lymphoma & non-acute leukemia w CC","code_information":[{"code":"403","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lymphoma & Non-Acute Leukemia w/o CC","code_information":[{"code":"404","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Childhood Mental Disorders","code_information":[{"code":"431","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Poisoning & toxic Effects of Drugs Age >17 w CC","code_information":[{"code":"449","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Complications of treatment w CC","code_information":[{"code":"452","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Combined Anterior And Posterior Spinal Fusion With Mcc","code_information":[{"code":"453","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Combined Anterior And Posterior Spinal Fusion With Cc","code_information":[{"code":"454","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Combined Anterior And Posterior Spinal Fusion Without Cc/Mcc","code_information":[{"code":"455","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Spinal Fusion Except Cervical With Mcc","code_information":[{"code":"459","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Spinal Fusion Except Cervical Without Mcc","code_information":[{"code":"460","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":35222.25,"10th_percentile":35222.25,"90th_percentile":35222.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major joint & limb reattachment proc of upper extremity w/o CC/MCC","code_information":[{"code":"484","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Back & neck proc exc spinal fusion w CC/MCC or disc device/neurostim","code_information":[{"code":"490","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Back & neck proc exc spinal fusion w/o CC/MCC","code_information":[{"code":"491","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Arthroscopy","code_information":[{"code":"509","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Alc/Drug Abuse or Depend w/o Rehabilitation therapy w/o CC","code_information":[{"code":"523","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Transient ischemia","code_information":[{"code":"524","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other heart assist system implant","code_information":[{"code":"525","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"No Longer Valid","code_information":[{"code":"526","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"No Longer Valid","code_information":[{"code":"527","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Intracranial Vascular Proc w Pdx Hemorrhage","code_information":[{"code":"528","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ventricular shunt procedures w CC","code_information":[{"code":"529","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ventricular Shunt Procedures w/o CC","code_information":[{"code":"530","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Spinal Procedures w CC","code_information":[{"code":"531","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Spinal Procedures w/o CC","code_information":[{"code":"532","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Stomach, Esophageal & Duodenal Proc Age > 17 w CC w Major Gi Dx","code_information":[{"code":"567","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Stomach, Esophageal & Duodenal Procedures Proc Age > 17 w CC w/o Major Gi Dx","code_information":[{"code":"568","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Small & Large Bowel Procedures w CC w Major Gi Dx","code_information":[{"code":"569","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Admit For Renal Dialysis","code_information":[{"code":"685","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Urinary Stones W Esw Lithotripsy W Cc/Mcc","code_information":[{"code":"691","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Urinary Stones W Esw Lithotripsy W/O Cc/Mcc","code_information":[{"code":"692","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cesarean Section W Cc/Mcc","code_information":[{"code":"765","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cesarean Section W/O Cc/Mcc","code_information":[{"code":"766","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Vaginal Delivery W Sterilization &/Or D&C","code_information":[{"code":"767","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Vaginal Delivery W Complicating Diagnoses","code_information":[{"code":"774","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Vaginal Delivery W/O Complicating Diagnoses","code_information":[{"code":"775","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ectopic Pregnancy","code_information":[{"code":"777","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Threatened Abortion","code_information":[{"code":"778","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"False Labor","code_information":[{"code":"780","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Antepartum Diagnoses W Medical Complications","code_information":[{"code":"781","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Antepartum Diagnoses W/O Medical Complications","code_information":[{"code":"782","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Prostatic O.R. Procedure Unrelated To Principal Diagnosis W Mcc","code_information":[{"code":"984","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Prostatic O.R. Procedure Unrelated To Principal Diagnosis W Cc","code_information":[{"code":"985","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Prostatic O.R. Procedure Unrelated To Principal Diagnosis W/O Cc/Mcc","code_information":[{"code":"986","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Principal Diagnosis Invalid As Discharge Diagnosis","code_information":[{"code":"998","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ungroupable","code_information":[{"code":"999","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 224205 | Total % of Charge: 56.5] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 17429 Days: 3 Additional Days: 2242] [Normal vag. Del. 2 day stay-Case Rate: 12451 Days: 2 Additional Days: 2242] [Nursery  Level 1- Boarder-Per Diem: 1162] [Nursery  Level 2-Per Diem: 2242] [Nursery  Level 3-Per Diem: 4897] [Nursery  Level 4-NICU-Per Diem: 5644] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 25000 (%BC): 21.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 161889 | Total % of Charge: 48.53] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145699 | Total % of Charge: 81.74] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP Prosthetics/Implants/Devices (%BC): 24.52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Careplus","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 273164 | Total % of Charge: 41.7] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15870 Days: 3 Additional Days: 1906] [Normal vag. Del. 2 day stay-Case Rate: 11107 Days: 2 Additional Days: 1906] [Nursery  Level 1- Boarder-Per Diem: 953] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 48095 (%BC): 18.1]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6439.44,"10th_percentile":6439.44,"90th_percentile":6439.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/] [Bariatric Surgery-Case Rate: 9357]","count":"1 through 10","median_amount":4391.65,"10th_percentile":4391.65,"90th_percentile":4391.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 155340 | Total % of Charge: 55.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 15056 Days: 4 Additional Days: 1807] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 1807] [Lower Level Neonate-Per Diem: 1807] [Higher Level Neonate-Per Diem: 3765] [Severe Level Neonate-per diem: 4516] [Nursery  Level 1- Boarder-Per Diem: 1131] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 14043 (%BC): 32]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]}]}